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Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran Publisher Pubmed

Summary: Study shows recalibrated SCORE and Globorisk models predict CVD mortality in Iran, with Globorisk better for high-risk women. #CVD #RiskPrediction

Fahimfar N1, 2 ; Fotouhi A1 ; Mansournia MA1 ; Malekzadeh R3 ; Sarrafzadegan N4, 5 ; Azizi F6 ; Mansourian M7 ; Sepanlou SG3 ; Emamian MH8 ; Hadaegh F6 ; Roohafza H9 ; Hashemi H10 ; Poustchi H3 ; Pourshams A3 Show All Authors
Authors
  1. Fahimfar N1, 2
  2. Fotouhi A1
  3. Mansournia MA1
  4. Malekzadeh R3
  5. Sarrafzadegan N4, 5
  6. Azizi F6
  7. Mansourian M7
  8. Sepanlou SG3
  9. Emamian MH8
  10. Hadaegh F6
  11. Roohafza H9
  12. Hashemi H10
  13. Poustchi H3
  14. Pourshams A3
  15. Samavat T11
  16. Sharafkhah M1, 3
  17. Talaei M4, 12
  18. Klaveren DV13
  19. Steyerberg EW13, 14
  20. Khalili D15, 16

Source: International Journal of Health Policy and Management Published:2022


Abstract

Background: Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region. Methods: We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models’ discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level. Results: After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766-0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%). Conclusion: Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women. © 2022 The Author(s);.
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