title: Developing and validating a cardiovascular risk score for patients in the community with prior cardiovascular disease.
abstract: Patients with atherosclerotic cardiovascular disease (CVD) vary significantly in their risk of future CVD events; yet few clinical scores are available to aid assessment of risk. We sought to develop a score for use in primary care that estimates short-term CVD risk in these patients.
  
  
  
  Adults aged <80 years with prior CVD were identified from a New Zealand primary care cohort study (PREDICT), and linked to national mortality, hospitalisation and dispensing databases. A Cox model with an outcome of myocardial infarction, stroke or CVD death within 2 years was developed. External validation was performed in a cohort from the UK.
  
  
  
  24 927 patients, 63% men, 63% European, median age 65 years (IQR 58-72 years), experienced 1480 CVD events within 2 years after a CVD risk assessment. A risk score including ethnicity, comorbidities, body mass index, creatine creatinine and treatment, in addition to established risk factors used in primary prevention, predicted a median 2-year CVD risk of 5.0% (IQR 3.5%-8.3%). A plot of actual against predicted event rates showed very good calibration throughout the risk range. The score performed well in the UK cohort but overestimated risk for those at highest risk, who were predominantly patients defined as having heart failure.
  
  
  
  The PREDICT-CVD secondary prevention score uses routine measurements from clinical practice that enable it to be implemented in a primary care setting. The score will facilitate risk communication between primary care practitioners and patients with prior CVD, particularly as a resource to show the benefit of risk factor modification.
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.|Department of Medicine, University of Auckland, Auckland, New Zealand.
authors.forename: Katrina K
authors.initials: KK
authors.lastname: Poppe
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand.|Greenlane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Rob N
authors.initials: RN
authors.lastname: Doughty
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Sue
authors.initials: S
authors.lastname: Wells
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Dudley
authors.initials: D
authors.lastname: Gentles
authors.affiliation: Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK.
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand.|Counties Manukau District Health Board, Middlemore Hospital, Auckland, New Zealand.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009520:New Zealand / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: cardiovascular disease; electronic health record; risk score; secondary prevention