Simple risk models to predict cardiovascular death in patients with stable coronary artery disease

Ford, I. et al. (2021) Simple risk models to predict cardiovascular death in patients with stable coronary artery disease. European Heart Journal: Quality of Care and Clinical Outcomes, 7(3), pp. 287-294. (doi: 10.1093/ehjqcco/qcz070) (PMID:31922541)

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Abstract

Aims: Risk estimation is important to motivate patients to adhere to treatment and to identify those in whom additional treatments may be warranted and expensive treatments might be most cost effective. Our aim was to develop a simple risk model based on readily available risk factors for patients with stable coronary artery disease (CAD). Methods and results: Models were developed in the CLARIFY registry of patients with stable CAD, first incorporating only simple clinical variables and then with the inclusion of assessments of left ventricular function, estimated glomerular filtration rate, and haemoglobin levels. The outcome of cardiovascular death over ∼5 years was analysed using a Cox proportional hazards model. Calibration of the models was assessed in an external study, the CORONOR registry of patients with stable coronary disease. We provide formulae for calculation of the risk score and simple integer points-based versions of the scores with associated look-up risk tables. Only the models based on simple clinical variables provided both good c-statistics (0.74 in CLARIFY and 0.80 or over in CORONOR), with no lack of calibration in the external dataset. Conclusion: Our preferred model based on 10 readily available variables [age, diabetes, smoking, heart failure (HF) symptom status and histories of atrial fibrillation or flutter, myocardial infarction, peripheral arterial disease, stroke, percutaneous coronary intervention, and hospitalization for HF] had good discriminatory power and fitted well in an external dataset. Study registration: The CLARIFY registry is registered in the ISRCTN registry of clinical trials (ISRCTN43070564).

Item Type:Articles
Additional Information:This work was in part supported by the RHU iVASC [ANR-16-RHUS- 00010] from the French National Research Agency (ANR) as part of the ‘Investissements d’Avenir’ programme. The CLARIFY registry, the SIGNIFY, and BEAUTIFUL trials were supported by Servier, the CORONOR registry and E.S. was supported by the Federation Francaise de Cardiologie (Paris, France). The CLARIFY study was funded by a research grant formServier.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Robertson, Mrs Michele and Greenlaw, Miss Nicola and Ford, Professor Ian
Authors: Ford, I., Robertson, M., Greenlaw, N., Bauters, C., Lemesle, G., Sorbets, E., Ferrari, R., Tardif, J.-C., Tendera, M., Fox, K., and Steg, P. G.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:European Heart Journal: Quality of Care and Clinical Outcomes
Publisher:Oxford University Press
ISSN:2058-5225
ISSN (Online):2058-1742
Published Online:10 January 2020
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in European Heart Journal: Quality of Care and Clinical Outcomes 7(3): 287-294
Publisher Policy:Reproduced under a Creative Commons License

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