Comparative accuracy of cardiovascular risk prediction methods in primary care patients

Citation
Af. Jones et al., Comparative accuracy of cardiovascular risk prediction methods in primary care patients, HEART, 85(1), 2001, pp. 37-43
Citations number
28
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Journal title
HEART
ISSN journal
1355-6037 → ACNP
Volume
85
Issue
1
Year of publication
2001
Pages
37 - 43
Database
ISI
SICI code
1355-6037(200101)85:1<37:CAOCRP>2.0.ZU;2-C
Abstract
Objective-To compare the relative accuracy of cardiovascular disease risk p rediction methods based on equations derived from the Framingham heart stud y. Design-Risk factor data were collected prospectively from subjects being ev aluated by their primary care physicians for prevention of cardiovascular d isease. Projected cardiovascular risks were calculated for each patient wit h the Framingham equations, and also estimated from the risk tables and cha rts based on the same equations. Setting-12 primary care practices (46 doctors) in Birmingham. Patients-691 subjects aged 30-70 years. Main outcome measures-Sensitivity, specificity, and positive and negative p redictive values of the Framingham based risk tables and charts for treatme nt thresholds based on projected cardiovascular disease or coronary heart d isease risk. Results-59 subjects (8.5%) had projected 10 year coronary heart disease ris ks greater than or equal to 30%, and 291 (42.1%) had risks greater than or equal to 15%. At equivalent projected risk levels (10 year coronary heart d isease greater than or equal to 30% and five year cardiovascular disease gr eater than or equal to 20%), the original Sheffield tables and those from N ew Zealand have the same sensitivities (40.0%, 95% confidence interval (CI) 26.6% to 57.8% v 41.2%, 95% CI 28.7% to 57.3%) and specificities (98.6%, 9 5% CI 97.2% to 99.3% v 99.7%, 95% CI 98.8% to 100%). Modifications to the S heffield tables improve sensitivity (91.4%, 95% CI 81.3% to 96.9%) but redu ce specificity (95.8%, 95% CI 93.9% to 97.3%). The revised joint British re commendations' charts have high specificity (98.7%, 95% CI 97.5% to 99.5%) and good sensitivity (84.7%, 95% CI 71.0% to 93.0%). Conclusions-The revised joint British recommendations charts appear to have the best combination of sensitivity and specificity for use in primary car e patients.