title: New approaches for improving cardiovascular risk assessment.
abstract: OBJECTIVE
  Clinical guidelines recommend the use of cardiovascular risk assessment tools (risk scores) to predict the risk of events such as cardiovascular death, since these scores can aid clinical decision-making and thereby reduce the social and economic costs of cardiovascular disease (CVD). However, despite their importance, risk scores present important weaknesses that can diminish their reliability in clinical contexts. This study presents a new framework, based on current risk assessment tools, that aims to minimize these limitations.
  
  
  METHODS
  Appropriate application and combination of existing knowledge is the main focus of this work. Two different methodologies are applied: (i) a combination scheme that enables data to be extracted and processed from various sources of information, including current risk assessment tools and the contributions of the physician; and (ii) a personalization scheme based on the creation of patient groups with the purpose of identifying the most suitable risk assessment tool to assess the risk of a specific patient.
  
  
  RESULTS
  Validation was performed based on a real patient dataset of 460 patients at Santa Cruz Hospital, Lisbon, Portugal, diagnosed with non-ST-segment elevation acute coronary syndrome. Promising results were obtained with both approaches, which achieved sensitivity, specificity and geometric mean of 78.79%, 73.07% and 75.87%, and 75.69%, 69.79% and 72.71%, respectively.
  
  
  CONCLUSIONS
  The proposed approaches present better performances than current CVD risk scores; however, additional datasets are required to back up these findings.
authors.affiliation: Polytechnic Institute of Coimbra (IPC/ISEC), Computer Science and Systems Engineering Department, Rua Pedro Nunes, 3030-199 Coimbra, Portugal; CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290 Coimbra, Portugal. Electronic address: sparedes@isec.pt.
authors.forename: Simão
authors.initials: S
authors.lastname: Paredes
authors.affiliation: Polytechnic Institute of Coimbra (IPC/ISEC), Computer Science and Systems Engineering Department, Rua Pedro Nunes, 3030-199 Coimbra, Portugal; CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290 Coimbra, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rocha
authors.affiliation: CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290 Coimbra, Portugal.
authors.forename: Diana
authors.initials: D
authors.lastname: Mendes
authors.affiliation: CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290 Coimbra, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Carvalho
authors.affiliation: CISUC, Center for Informatics and Systems of University of Coimbra, University of Coimbra, Pólo II, 3030-290 Coimbra, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Henriques
authors.affiliation: Cardiology Department, Leiria Hospital Centre, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Morais
authors.affiliation: Cardiology Department, Santa Cruz Hospital, Lisbon, Portugal.
authors.forename: Jorge
authors.initials: J
authors.lastname: Ferreira
authors.affiliation: Cardiology Department, Santa Cruz Hospital, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D011174:Portugal; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors
keywords: Avaliação de risco cardiovascular; Cardiovascular risk assessment; Classificadores de risco; Clinical decision support systems; Combinação de modelos; Model combination; Personalization; Personalização; Risk scores; Sistemas de apoio à decisão clínica