Prognostic models for stable coronary artery disease based on electronic health record cohort of 102 023 patients

Abstract

Aims The population with stable coronary artery disease (SCAD) is growing but validated models to guide their clinical management are lacking. We developed and validated prognostic models for all-cause mortality and non-fatal myocardial infarction (MI) or coronary death in SCAD. Methods and results Models were developed in a linked electronic health records cohort of 102 023 SCAD patients from the CALIBER programme, with mean follow-up of 4.4 (SD 2.8) years during which 20 817 deaths and 8856 coronary outcomes were observed. The Kaplan–Meier 5-year risk was 20.6% (95% CI, 20.3, 20.9) for mortality and 9.7% (95% CI, 9.4, 9.9) for non-fatal MI or coronary death. The predictors in the models were age, sex, CAD diagnosis, deprivation, smoking, hypertension, diabetes, lipids, heart failure, peripheral arterial disease, atrial fibrillation, stroke, chronic kidney disease, chronic pulmonary disease, liver disease, cancer, depression, anxiety, heart rate, creatinine, white cell count, and haemoglobin. The models had good calibration and discrimination in internal (external) validation with C-index 0.811 (0.735) for all-cause mortality and 0.778 (0.718) for non-fatal MI or coronary death. Using these models to identify patients at high risk (defined by guidelines as 3% annual mortality) and support a management decision associated with hazard ratio 0.8 could save an additional 13-16 life years or 15-18 coronary event-free years per 1000 patients screened, compared with models with just age, sex, and deprivation. Conclusion These validated prognostic models could be used in clinical practice to support risk stratification as recommended in clinical guidelines.

Ischemia and No Obstructive Coronary Artery Disease (INOCA): What Is the Risk?

“…Additional scores developed for secondary prevention in patients with established cardiovascular disease (CVD) do not include obstructive CAD as a variable, but were developed in populations dominated by obstructive CAD,63, 65, 66, 67, 68, 69, 70, 71 and therefore are of unknown appropriateness for stable INOCA patients.…”

“…The “Cardiovascular Disease Research Using Linked Bespoke Studies and Electronic Health Records” (CALIBER) score67 used real‐world commonly available data that contributed to important prognostic information in unselected patients with a wide phenotype of stable ischemic heart disease. The CALIBER models had good calibration and discrimination in internal and external validation with C‐index 0.811 (0.735) for all‐cause mortality and 0.778 (0.718) for nonfatal MI or coronary death in established stable ischemic heart disease 67…”

“…Comparison of primary, secondary prevention risk versus observed risk in an example of stable INOCA patient is presented in Figure 2 40, 47, 56, 63, 65, 66, 67, 68, 69, 70, 71. The primary prevention scores, developed in asymptomatic populations, predicted that risks vary between 1% and ≈5% and underestimate the observed INOCA risk.…”

Discharge of Non–Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner–Led Chest Pain Clinic

“…Prognosis can be improved through identification, risk stratification and prevention strategies. 36,37 These patients had the opportunity for early diagnosis, education and treatment which may lead to increased prevention behaviours and could can be seen as prevention of future ACS.…”

Hypertension Screening Using Blood Pressure to Height Ratio

“…2 In addition, it is well established that childhood hypertension tracks into adulthood, 3 which increases the future risk of cardiovascular disease (CVD). 4 Therefore, it is important to identify prehypertension and hypertension in childhood to prevent CVD in early adulthood.…”