Prioritising cardiovascular disease risk assessment to high risk individuals based on primary care records
Author:
Chung RyanORCID,
Xu ZheORCID,
Arnold Matthew,
Stevens David,
Keogh Ruth,
Barrett Jessica,
Harrison Hannah,
Pennells Lisa,
Kim Lois G.ORCID,
DiAngelantonio Emanuele,
Paige EllieORCID,
Usher-Smith Juliet A.ORCID,
Wood Angela M.
Abstract
Objective
To provide quantitative evidence for systematically prioritising individuals for full formal cardiovascular disease (CVD) risk assessment using primary care records with a novel tool (eHEART) with age- and sex- specific risk thresholds.
Methods and analysis
eHEART was derived using landmark Cox models for incident CVD with repeated measures of conventional CVD risk predictors in 1,642,498 individuals from the Clinical Practice Research Datalink. Using 119,137 individuals from UK Biobank, we modelled the implications of initiating guideline-recommended statin therapy using eHEART with age- and sex-specific prioritisation thresholds corresponding to 5% false negative rates to prioritise adults aged 40–69 years in a population in England for invitation to a formal CVD risk assessment.
Results
Formal CVD risk assessment on all adults would identify 76% and 49% of future CVD events amongst men and women respectively, and 93 (95% CI: 90, 95) men and 279 (95% CI: 259, 297) women would need to be screened (NNS) to prevent one CVD event. In contrast, if eHEART was first used to prioritise individuals for formal CVD risk assessment, we would identify 73% and 47% of future events amongst men and women respectively, and a NNS of 75 (95% CI: 72, 77) men and 162 (95% CI: 150, 172) women. Replacing the age- and sex-specific prioritisation thresholds with a 10% threshold identify around 10% less events.
Conclusions
The use of prioritisation tools with age- and sex-specific thresholds could lead to more efficient CVD assessment programmes with only small reductions in effectiveness at preventing new CVD events.
Funder
British Heart Foundation
BHF Cambridge Centre of Research Excellence
NIHR Cambridge Biomedical Research Centre
Medical Research Council
Chinese Scholarship Council
NIHR BTRU in Donor Health and Genomics
NIHR BTRU in Donor Health and Behaviour
NIHR Advanced Fellowship
Innovative Medicines Initiative-2 Joint Undertaking
BHF-Turing Cardiovascular Data Science Award
Publisher
Public Library of Science (PLoS)
Subject
Multidisciplinary
Reference40 articles.
1. WHO/Europe | Cardiovascular diseases ‐ Data and statistics [Internet]. [cited 2022 Apr 1]. Available from: https://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/data-and-statistics
2. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute CVD risk 2012 [Internet]. 2012 [cited 2021 Nov 23]. Available from: https://informme.org.au/en/Guidelines/Guidelines-for-the-assessment-and-management-of-absolute-CVD-risk
3. ESC Guidelines on cardiovascular disease prevention in clinical practice;FLJ Visseren;Eur Heart J,2021
4. New Zealand Ministry of Health;Cardiovascular Disease Risk Assessment and Management for Primary Care,2018
5. ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines;DK Arnett;Circulation,2019