1. Performance of risk prediction scores for cardiovascular mortality in older persons: External validation of the SCORE OP and appraisal.
- Author
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Piccininni M, Rohmann JL, Huscher D, Mielke N, Ebert N, Logroscino G, Schäffner E, and Kurth T
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Kaplan-Meier Estimate, Male, Probability, Reproducibility of Results, Risk Factors, Cardiovascular Diseases mortality, Risk Assessment
- Abstract
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., Competing Interests: 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.
- Published
- 2020
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