Deo, S. V. et al. (2024) Impact of residential social deprivation on prediction of heart failure in patients with type 2 diabetes: External validation and recalibration of the WATCH-DM score using real world data. Circulation: Cardiovascular Quality and Outcomes, 17(3), pp. 267-276. e010166. (doi: 10.1161/circoutcomes.123.010166) (PMID:38328913)
Full text not currently available from Enlighten.
Abstract
BACKGROUND: Patients with type 2 diabetes are at risk of heart failure hospitalization. As social determinants of health are rarely included in risk models, we validated and recalibrated the WATCH-DM score in a diverse patient-group using their social deprivation index (SDI). METHODS: We identified US Veterans with type 2 diabetes without heart failure that received outpatient care during 2010 at Veterans Affairs medical centers nationwide, linked them to their SDI using residential ZIP codes and grouped them as SDI <20%, 21% to 40%, 41% to 60%, 61% to 80%, and >80% (higher values represent increased deprivation). Accounting for all-cause mortality, we obtained the incidence for heart failure hospitalization at 5 years follow-up; overall and in each SDI group. We evaluated the WATCH-DM score using the C statistic, the Greenwood Nam D’Agostino test χ2 test and calibration plots and further recalibrated the WATCH-DM score for each SDI group using a statistical correction factor. RESULTS: In 1 065 691 studied patients (mean age 67 years, 25% Black and 6% Hispanic patients), the 5-year incidence of heart failure hospitalization was 5.39%. In SDI group 1 (least deprived) and 5 (most deprived), the 5-year heart failure hospitalization was 3.18% and 11%, respectively. The score C statistic was 0.62; WATCH-DM systematically overestimated heart failure risk in SDI groups 1 to 2 (expected/observed ratios, 1.38 and 1.36, respectively) and underestimated the heart failure risk in groups 4 to 5 (expected/observed ratios, 0.95 and 0.80, respectively). Graphical evaluation demonstrated that the recalibration of WATCH-DM using an SDI group-based correction factor improved predictive capabilities as supported by reduction in the χ2 test results (801–27 in SDI groups I; 623–23 in SDI group V). CONCLUSIONS: Including social determinants of health to recalibrate the WATCH-DM score improved risk prediction highlighting the importance of including social determinants in future clinical risk prediction models.
| Item Type: | Articles |
|---|---|
| Additional Information: | This work was partly funded by the National Institute on Minority Health and Health Disparities Award No. P50MD017351. |
| Keywords: | Cardiology and Cardiovascular Medicine |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McAllister, Professor David and Sattar, Professor Naveed and Petrie, Professor Mark and Deo, Salil |
| Authors: | Deo, S. V., Al-Kindi, S., Motairek, I., McAllister, D., Shah, A. S.V., Elgudin, Y. E., Gorodeski, E. Z., Virani, S., Petrie, M. C., Rajagopalan, S., and Sattar, N. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment |
| Journal Name: | Circulation: Cardiovascular Quality and Outcomes |
| Publisher: | Lippincott, Williams and Wilkins for the American Heart Association |
| ISSN: | 1941-7705 |
| ISSN (Online): | 1941-7713 |
| Published Online: | 08 February 2024 |
University Staff: Request a correction | Enlighten Editors: Update this record
Deposit and Record Details
Deposit and Record Details