Lotte Verweij1, Ron J G Peters2, Wilma J M Scholte Op Reimer3, S Matthijs Boekholdt2, Robert M Luben4, Nicholas J Wareham4, Kay-Tee Khaw5, Corine H M Latour6, Harald T Jorstad2. 1. ACHIEVE Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. Electronic address: l.verweij@hva.nl. 2. Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands. 3. ACHIEVE Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands; Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands. 4. Medical Research Council Epidemiology Unit, University of Cambridge, United Kingdom. 5. Department of Public Health and Primary Care, University of Cambridge, United Kingdom. 6. ACHIEVE Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
Abstract
BACKGROUND: The Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) algorithm is developed to assess 10-year risk of death due to cardiovascular disease (CVD) in individuals aged ≥65 years. We studied the performance of SCORE-OP in the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. METHODS: 10-year CVD mortality as predicted by SCORE-OP was compared with observed CVD mortality among individuals in the EPIC-Norfolk cohort. Persons aged 65-79 years without known CVD were included in the analysis. CVD mortality was defined as death due to ischemic heart disease, cardiac failure, cerebrovascular disease, peripheral-artery disease or aortic aneurysm. Predicted 10-year CVD mortality was calculated by the SCORE-OP algorithm, and compared to observed mortality rates. The area under the receiver operator characteristics curve (AUROC) was calculated to evaluate discriminative power. Calibration was evaluated by calculating ratios of predicted vs observed mortality and by Hosmer-Lemeshow tests. RESULTS: A total of 6590 individuals (45.8% men), mean age 70.2 years (standard deviation 3.3) were included. The predicted mortality by SCORE-OP was 9.84% (95% confidence interval (CI) 9.76-9.92) and observed mortality was 10.2% (95% CI 9.52-11.04), ratio 0.96. AUROC was 0.63 (95% CI 0.60-0.65), and X2 was 3.3 (p = 0.92). CONCLUSION: SCORE-OP overall accurately estimates the rate of CVD mortality in a general population aged 65-79 years. However, while calibration is excellent, the discriminative power of the SCORE-OP is limited, and as such cannot be readily implemented in clinical practice for this population.
BACKGROUND: The Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) algorithm is developed to assess 10-year risk of death due to cardiovascular disease (CVD) in individuals aged ≥65 years. We studied the performance of SCORE-OP in the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. METHODS: 10-year CVDmortality as predicted by SCORE-OP was compared with observed CVDmortality among individuals in the EPIC-Norfolk cohort. Persons aged 65-79 years without known CVD were included in the analysis. CVDmortality was defined as death due to ischemic heart disease, cardiac failure, cerebrovascular disease, peripheral-artery disease or aortic aneurysm. Predicted 10-year CVDmortality was calculated by the SCORE-OP algorithm, and compared to observed mortality rates. The area under the receiver operator characteristics curve (AUROC) was calculated to evaluate discriminative power. Calibration was evaluated by calculating ratios of predicted vs observed mortality and by Hosmer-Lemeshow tests. RESULTS: A total of 6590 individuals (45.8% men), mean age 70.2 years (standard deviation 3.3) were included. The predicted mortality by SCORE-OP was 9.84% (95% confidence interval (CI) 9.76-9.92) and observed mortality was 10.2% (95% CI 9.52-11.04), ratio 0.96. AUROC was 0.63 (95% CI 0.60-0.65), and X2 was 3.3 (p = 0.92). CONCLUSION: SCORE-OP overall accurately estimates the rate of CVDmortality in a general population aged 65-79 years. However, while calibration is excellent, the discriminative power of the SCORE-OP is limited, and as such cannot be readily implemented in clinical practice for this population.
Authors: Patricia Jepma; Harald T Jorstad; Marjolein Snaterse; Gerben Ter Riet; Hans Kragten; Sangeeta Lachman; Madelon Minneboo; S Matthijs Boekholdt; Ron J Peters; Wilma Scholte Op Reimer Journal: Heart Date: 2020-03-16 Impact factor: 5.994