Medical information system for the rapid screening of cardiovascular risk in patients after coronary stenting

Abstract

Aim. To develop and implement a decision support system for a software product – medical information system “1C: Medicine” in the form of calculator for assessment of the absolute risk of death from cardiovascular diseases (CVD) and to show the prospects of using this system for patients with coronary artery disease (CAD) after coronary stenting.Material and Methods. The medical information system “1C: Medicine” software interface was developed in Tyumen Cardiology Research Center. It was designed to assess 10-year absolute total mortality risk from CVD in males of working age (Tyumen Risk Scale (TRS)) to provide medical decision support. The program was tested in 764 male patients from the Prospective Registry of Percutaneous Coronary Interventions (PCI). The mean age of patients was 56.9 ± 8.8 years. All death cases, recorded within a year after PCI (n = 23), were used as the status check variable. The following algorithms were chosen to compare the predictive accuracy of the integrated model: PROCAM and FRAMINGHAM. The Schwarz information test and ROC analysis data were used to assess the predictive accuracy of the models.Results. The values of Schwarz’s criterion in males were 283 for TRS, 235 for PROCAM, and 490 for FRAMINGHAM model. AUC indicator for TRS was 0.655 (95% CI 0.510–0.800), suggesting the satisfactory quality of resulting model. AUC indicators for FRAMINGHAM and PROCAM algorithms were 0.599 (95% CI 0.442–0.757) and 0.653 (95% CI 0.509–0.796), respectively.Conclusion. The created TRS, integrated into the medical information system with psychosocial factors, may be quickly and successfully implemented to determine mortality risk in CAD patients within one year after coronary stenting. The TRS has an advantage over the traditional FRAMINGHAM risk scale and non-inferior to the PROCAM scale. Therefore, TRS may be used as a medical decision support program.