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Most cardiovascular risk prediction equations need to be updated or replaced

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The majority of cardiovascular disease (CVD) risk prediction equations are derived from cohorts established last century that included participants at higher risk, on less treatment and who were less socio-economically and ethnically diverse, than patients the equations are now applied to.

The validity of most of these equations is uncertain, largely because the relevant cohorts required to evaluate them are rare. Approximately 90% of middle-aged New Zealanders have had quantitative CVD risk assessments using a Framingham Heart Study equation (FHSE), since risk assessment was made a national primary healthcare priority in 2008. We piggybacked on this initiative to recruit a nationally representative primary care cohort to: i. assess the validity of the 2013 Pooled Studies equations (PCEs) that recently replaced FHS Es in the US and elsewhere; and ii. develop new equations if justified.

We demonstrate that a contemporary cohort representing typical patients that prediction equations are applied to, can be recruited using decision support integrated with routine linked electronic patient records. We show that new US risk prediction equations substantially overestimate observed CVD risk and this is not explained by new drug treatment. Recalibration would be insufficient to improve the performance of the PCEs and simple variables representing common ethnicities and socio-economic deprivation should be incorporated into current equations.

New equations are provided that could be implemented in the 15-20 high-income countries with relatively similar CVD events rates and healthcare systems to New Zealand.

This talk is part of the Cambridge Cardiovascular Seminar Series series.

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