Agreement Among Cardiovascular Disease Risk Calculators

Abstract

Background-Use of cardiovascular disease risk calculators is often recommended by guidelines, but research on consistency in risk assessment among calculators is limited. Method and Results-A search of PubMed and Google was performed. Five clinicians selected 25 calculators by independent review. Hypothetical patients were created with the use of 7 risk factors (age, sex, smoking, blood pressure, high-density lipoprotein, total cholesterol, and diabetes mellitus) dichotomized to high and low, generating 2 7 patients (128 total). These patients were assessed by each calculator by 2 clinicians. Risk estimates (and assigned risk categories) were compared among calculators. Selected calculators were from 8 countries, used 5-or 10-year predictions, and estimated either cardiovascular disease or coronary heart disease. With the use of 3 risk categories (low, medium, and high), the 25 calculators categorized each patient into a mean of 2.2 different categories, and 41% of unique patients were assigned across all 3 risk categories. Risk category agreement between pairs of calculators was 67%. This did not improve when analysis was limited to just the 10-year cardiovascular disease calculators. In nondiabetics, the highest calculated risk estimate from a calculator averaged 4.9 times higher (range, 1.9-13.3) than the lowest calculated risk estimate for the same patient. This did not change meaningfully for diabetics or when the analysis was limited to 10-year cardiovascular disease calculators. Conclusions-The decision as to which calculator to use for risk estimation has an important impact on both risk categorization and absolute risk estimates. This has broad implications for guidelines recommending therapies based on specific calculators.

Modelos predictivos de riesgo cardiovascular

“…En caso de estratifi cación ésta se puede realizar usando solamente los factores de ries-go o mediante el uso de modelos predictivos. Aún hace falta indagar sobre cómo afectan los factores de riesgo emergentes, el cómo se pueden aprovechar condiciones como la tasa de fi ltración glomerular, la proteinuria y la albuminuria, así como el rol de los nuevos biomarcadores y técnicas usadas para la detección de aterosclerosis en estos pacientes (20,37,38).…”

Comparative Analysis of the Calculation Models for Ischemic Heart Disease Overall Risk in Railroad Workers

“…В то же время в Германии распространена шкала PROCAM, в Великобрита-нии -QRISK и ASSIGN, в Финляндии -FINRISK, в Италии -Progetto CUORE, в США -шкала Framingham. По данным Allan GM, et al, согласован-ность этих и других шкал в оценке категории риска (низкий, средний, высокий) в среднем составляет 67% [4]. Столь невысокий показатель можно объяс-нять различиями в перечне включаемых в расчет фак-торов риска и рядом особенностей когорт пациентов, в которых эти шкалы были изучены.…”

“…Причем разница в паре SCORE и Framingham была относительно небольшой, но она оказалась очень существенной при сравнении их со шкалой PROCAM. Это в целом совпадает с данными, приве-денными в работе Allan GM, et al [4], где совпадения уровня риска по калькуляторам SCORE и PROCAM составили 61% для лиц без сахарного диабета и 67% -с диабетом, для пары Framingham и PROCAM -61 и 66%, соответственно.…”

Vascular Risk Calculators

“…7,8 Most of these risk calculators are now available as electronic tools that mathematically combine multiple individual risk factors to predict a patient's probability of having a vascular event over the next 5 or 10 years. 9 It is therefore of considerable concern that this issue of Circulation reports on a comparison of 25 CVD risk calculators using 128 hypothetical patients that found up to a 5-fold difference in predicted CVD risk for the same patient. 9 The authors rightly conclude that the choice of calculator will have "an important impact on both risk categorization and absolute risk estimates.…”

“…9 It is therefore of considerable concern that this issue of Circulation reports on a comparison of 25 CVD risk calculators using 128 hypothetical patients that found up to a 5-fold difference in predicted CVD risk for the same patient. 9 The authors rightly conclude that the choice of calculator will have "an important impact on both risk categorization and absolute risk estimates. "…”