Reliability between Cardiovascular Risk Assessment Tools: A Pilot Study

Abstract

Background: The prevention of cardiovascular disease (CVD) is important in clinical practice due to its high morbidity and mortality. Different guidelines have recommended the use of different cardiovascular risk assessment tools, which may have implications on therapeutic decisions. Objective: To evaluate the agreement rate between the Framingham risk score (FRS) and the Systematic Coronary Risk Evaluation (SCORE) tool on CVD risk assessment in disease-free subjects. Methods: Cross-sectional study with a sample of 51 subjects treated at the outpatient clinic of a university hospital in Brazil between January 2014 and January 2015. The FRS and two versions of the European SCORE (SCORE-High and SCORE-Low) were used to assess CVD risk; patients were classified as low/moderate risk (< 20% and <5%, respectively) or high risk (≥ 20% and ≥5%, respectively). The agreement rate was evaluated using kappa statistics, a test for interrater reliability that ranges from-1 to 1, and results above 0.6 represent a high agreement rate. Results: The FRS classified a higher proportion of subjects as high risk for CVD (35.3% [18/51] vs. 23.5% [12/51] with the SCORE-High and 13.7% [7/51] with SCORE-Low). However, there was a high agreement rate between FRS and SCORE-High (k=0.628). The agreement between FRS and SCORE-Low was poor (k=0.352). Conclusions: There was a high agreement rate between FRS and SCORE-High in cardiovascular risk assessment in the study sample.

What is the best Cardiovascular Risk Score for the Brazilian Population?

“…Patients with diabetes are at high cardiovascular risk regardless of the score used. 4 In the study by Marasciulo et al 5 people with diabetes represented 27.5% of the sample. The Framingham score classified 71.4% of these patients as high-risk.…”

“…In order to extend the risk prediction, some models are able to estimate 30-year or lifelong risks, but they require validations in different populations. 3 Marasciulo et al 5 compared the use of SCORE with the Framingham risk score in a Brazilian population. 5 The SCORE tool used data from more than 250 000 individuals in 12 European countries to predict cardiovascular death in 10 years, with different models for countries with high or low incidence of cardiovascular disease (SCORE-High and SCORE-Low, respectively).…”

“…3 Marasciulo et al 5 compared the use of SCORE with the Framingham risk score in a Brazilian population. 5 The SCORE tool used data from more than 250 000 individuals in 12 European countries to predict cardiovascular death in 10 years, with different models for countries with high or low incidence of cardiovascular disease (SCORE-High and SCORE-Low, respectively). 6 The study was conducted at a university hospital with 51 patients aged between 40 and 65 years and without a diagnosis of cardiovascular disease.…”

“…Finally, the Framingham score showed a good correlation with the SCORE-High but not with the SCORE-Low, suggesting that the SCORE-High may be a good alternative in the Brazilian population. 5 No risk score has ever been designed for the Brazilian population, leading physicians to use scores that were created using populations with different characteristics.…”