Performance of risk prediction scores for cardiovascular mortality in older persons: External validation of the SCORE OP and appraisal.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
27
10
2019
accepted:
16
03
2020
entrez:
10
4
2020
pubmed:
10
4
2020
medline:
8
7
2020
Statut:
epublish
Résumé
European guidelines recommend the use of the Systematic COronary Risk Evaluation (SCORE) to assess 10-year risk of fatal cardiovascular events in people aged 40 to 65. The SCORE Older Persons (SCORE OP, 5-year and 10-year versions) was recently developed for people aged 65 or older. We assessed the performance of these risk scores in predicting fatal cardiovascular events in older persons in Berlin. Data from the Berlin Initiative Study (BIS), a prospective, population-based study of older persons recruited from a German public health insurance company database were used. 1,657 participants aged 70 or older without reported previous myocardial infarction were included. We assessed calibration by comparing predicted risks to observed (for 5-year versions, 5y) or projected (for 10-year versions) probabilities. During follow-up (median: 4.8 years), 118 cardiovascular deaths occurred. The calibration assessment of the SCORE OP-H 5y and SCORE OP-L 5y equations revealed 2.1- and 1.5-fold overestimation. Comparing 10-year versions, the SCORE OP showed better discrimination ability compared to the SCORE (C-indices of around 0.80 compared to 0.72) and the SCORE for high-risk regions showed the best calibration (chi-square = 29.68). The SCORE OP overestimated the true risk; 519 and 677 events were predicted using the low-risk and high-risk region SCORE OP equations compared to 397 to 399 events projected based on BIS follow-up data (predicted/actual ratios of 1.3 and 1.7). Given the low transportability of the SCORE OP observed in our population, we caution against its use in routine clinical practice until further information is available to avoid possible overtreatment among older persons in Berlin.
Sections du résumé
BACKGROUND
European guidelines recommend the use of the Systematic COronary Risk Evaluation (SCORE) to assess 10-year risk of fatal cardiovascular events in people aged 40 to 65. The SCORE Older Persons (SCORE OP, 5-year and 10-year versions) was recently developed for people aged 65 or older. We assessed the performance of these risk scores in predicting fatal cardiovascular events in older persons in Berlin.
METHODS AND FINDINGS
Data from the Berlin Initiative Study (BIS), a prospective, population-based study of older persons recruited from a German public health insurance company database were used. 1,657 participants aged 70 or older without reported previous myocardial infarction were included. We assessed calibration by comparing predicted risks to observed (for 5-year versions, 5y) or projected (for 10-year versions) probabilities. During follow-up (median: 4.8 years), 118 cardiovascular deaths occurred. The calibration assessment of the SCORE OP-H 5y and SCORE OP-L 5y equations revealed 2.1- and 1.5-fold overestimation. Comparing 10-year versions, the SCORE OP showed better discrimination ability compared to the SCORE (C-indices of around 0.80 compared to 0.72) and the SCORE for high-risk regions showed the best calibration (chi-square = 29.68). The SCORE OP overestimated the true risk; 519 and 677 events were predicted using the low-risk and high-risk region SCORE OP equations compared to 397 to 399 events projected based on BIS follow-up data (predicted/actual ratios of 1.3 and 1.7).
CONCLUSIONS
Given the low transportability of the SCORE OP observed in our population, we caution against its use in routine clinical practice until further information is available to avoid possible overtreatment among older persons in Berlin.
Identifiants
pubmed: 32271825
doi: 10.1371/journal.pone.0231097
pii: PONE-D-19-29827
pmc: PMC7144969
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0231097Commentaires et corrections
Type : ErratumIn
Déclaration de conflit d'intérêts
We have read the journal's policy and the authors of this manuscript have the following competing interests: We declare no support or financial relationships with any organisation for the submitted work. Outside of the submitted work: JLR, MP and NM have nothing further to disclose. DH received travel reimbursement from Actelion Switzerland and Böhringer-Ingelheim Germany for analysis project meetings. NE has received honoraria from Siemens Healthcare for presenting data on kidney function. GL serves as associate editor for the Neuroepidemiology journal, Karger. He received funding from Italian Ministry of Health, Italian Ministry of University and Research and Regione Puglia Special program for research. He further received speaking honoraria from Lilly, GE healthcare and Lundbeck. ES has received honoraria from Siemens Healthcare and Fresenius Medical Care for giving a lecture on kidney function assessment as well as from Fresenius Kabi for providing lectures and chairing a workshop on critiquing the literature. TK reports having contributed to an advisory board of CoLucid and a research project funded by Amgen, for which the Charité – Universitätsmedizin Berlin received an unrestricted compensation. He further reports having received honoraria from Lilly, Newsenselab, and Total for providing methodological advice, from Novartis and from Daiichi Sankyo for providing a lecture on neuroepidemiology and research methods, and from the BMJ for editorial services. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Circulation. 1998 May 12;97(18):1837-47
pubmed: 9603539
Circulation. 2008 Feb 12;117(6):743-53
pubmed: 18212285
Eur J Cardiovasc Prev Rehabil. 2010 Apr;17(2):244-9
pubmed: 20195155
BMJ. 1995 Apr 8;310(6984):901-4
pubmed: 7719179
Rev Esp Cardiol (Engl Ed). 2016 Oct;69(10):981-983
pubmed: 27474480
Med Clin (Barc). 2016 Nov 4;147(9):381-386
pubmed: 27575527
Eur Heart J. 2003 Jun;24(11):987-1003
pubmed: 12788299
Hellenic J Cardiol. 2007 Mar-Apr;48(2):55-63
pubmed: 17489342
Int J Cardiol. 2019 Oct 15;293:226-230
pubmed: 31324398
J Am Coll Cardiol. 2009 Sep 29;54(14):1209-27
pubmed: 19778661
Eur J Prev Cardiol. 2019 Jan 6;:2047487318821250
pubmed: 30614262
Atherosclerosis. 2016 Sep;252:207-274
pubmed: 27664503
Circulation. 2010 Jul 20;122(3):300-10
pubmed: 20644026
Int J Cardiol. 2010 Sep 3;143(3):385-90
pubmed: 19386372
Eur J Prev Cardiol. 2013 Oct;20(5):827-36
pubmed: 22498473
Expert Opin Drug Saf. 2014 Jan;13(1):57-65
pubmed: 24073682
Eur J Cardiovasc Prev Rehabil. 2008 Aug;15(4):402-8
pubmed: 18677163
Am J Cardiol. 1976 Jul;38(1):46-51
pubmed: 132862
Am Heart J. 2007 Jul;154(1):87-93
pubmed: 17584559
BMJ. 2016 May 16;353:i2416
pubmed: 27184143
BMJ Open. 2018 Mar 22;8(3):e019003
pubmed: 29567842
Eur J Epidemiol. 2010 Mar;25(3):203-10
pubmed: 20094758
Nephrol Dial Transplant. 2017 Jun 1;32(6):997-1005
pubmed: 27190381
BMJ. 1994 Jul 2;309(6946):23-7
pubmed: 8044063
Stat Med. 2016 Jan 30;35(2):214-26
pubmed: 26553135
Eur Heart J. 2018 Sep 1;39(33):3021-3104
pubmed: 30165516
BMJ Open. 2017 Mar 24;7(3):e013650
pubmed: 28341688
Eur J Prev Cardiol. 2016 Jul;23(10):1093-103
pubmed: 26040999
Eur Heart J. 2015 Sep 21;36(36):2446-53
pubmed: 26082084
Lancet. 2014 Feb 22;383(9918):669
pubmed: 24560042
Dtsch Arztebl Int. 2016 Mar 18;113(11):177-82
pubmed: 27118665
PLoS One. 2012;7(3):e34287
pubmed: 22470551
Eur Heart J. 2017 Aug 1;38(29):2259-2263
pubmed: 27941016
PLoS One. 2016 Sep 09;11(9):e0162188
pubmed: 27612145
Atherosclerosis. 2016 Oct;253:281-344
pubmed: 27594540
JRSM Cardiovasc Dis. 2017 Jan 01;6:2048004016687211
pubmed: 28286646