Development and validation of a cardiovascular risk score for patients in the community after acute coronary syndrome

• Published in: Heart (British Cardiac Society) Vol. 106; no. 7; pp. 506 - 511
• Main Authors: Poppe, Katrina K, Doughty, Rob N, Wells, Susan, Wu, Billy, Earle, Nikki J, Richards, A Mark, Troughton, Richard W, Jackson, Rod, Kerr, Andrew J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2020; BMJ Publishing Group LTD
• Subjects: acute coronary syndrome; Acute coronary syndromes; Body mass index; Cardiac risk factors and prevention; Diabetes; Ethics; Ethnicity; Heart attacks; Laboratories; Mortality; Patients; Primary care; Risk assessment; risk score; secondary prevention; Sensitivity analysis; Software; Studies; New Zealand; acute coronary syndrome; secondary prevention; risk score
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2019-315809

ObjectiveFollowing acute coronary syndrome (ACS), patients are managed long-term in the community, yet few tools are available to guide patient-clinician communication about risk management in that setting. We developed a score for predicting cardiovascular disease (CVD) risk among patients managed in the community after ACS.MethodsAdults aged 30–79 years with prior ACS were identified from a New Zealand primary care CVD risk management database (PREDICT) with linkage to national mortality, hospitalisation, pharmaceutical dispensing and regional laboratory data. A Cox model incorporating clinically relevant factors was developed to estimate the time to a subsequent fatal or non-fatal CVD event and transformed into a 5-year risk score. External validation was performed in patients (Coronary Disease Cohort Study) assessed 4 months post-ACS.ResultsThe PREDICT-ACS cohort included 13 703 patients with prior hospitalisation for ACS (median 1.9 years prior), 69% men, 58% European, median age 63 years, who experienced 3142 CVD events in the subsequent 5 years. Median estimated 5 year CVD risk was 24% (IQR 17%–35%). The validation cohort consisted of 2014 patients, 72% men, 92% European, median age 67 years, with 712 CVD events in the subsequent 5 years. Median estimated 5-year risk was 33% (IQR 24%–51%). The risk score was well calibrated in the derivation and validation cohorts, and Harrell’s c-statistic was 0.69 and 0.68, respectively.ConclusionsThe PREDICT-ACS risk score uses data routinely available in community care to predict the risk of recurrent clinical events. It was derived and validated in real-world contemporary populations and can inform management decisions with patients living in the community after experiencing an ACS.