Performance of risk prediction scores for cardiovascular mortality in older persons: External validation of the SCORE OP and appraisal.

Marco Piccininni,Elke Schäffner,Nina Mielke,Jessica L Rohmann,Tobias Kurth,Natalie Ebert,Giancarlo Logroscino,Dörte Huscher,Bart Ferket

doi:10.1371/journal.pone.0231097

Abstract

BackgroundEuropean 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 findingsData 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).ConclusionsGiven 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.

Highlights

Cardiovascular (CV) diseases are a leading cause of morbidity and are responsible for approximately 40% of deaths in the European Union[1] and 30% of deaths worldwide[2]
Given the low transportability of the Systematic COronary Risk Evaluation (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
The original SCORE is recommended for individuals aged 40 to 65 by the European guidelines on CV disease prevention from the European Society of Cardiology[14], and has been re-calibrated in various European countries to account for differences in mortality rates and risk factor distributions[15,16,17,18]

Summary

Introduction

Cardiovascular (CV) diseases are a leading cause of morbidity and are responsible for approximately 40% of deaths in the European Union[1] and 30% of deaths worldwide[2]. The Systematic COronary Risk Evaluation (SCORE) was developed in 2003 to predict the 10-year risk of CV disease mortality in European populations using data from twelve European cohort studies[13]. The original SCORE is recommended for individuals aged 40 to 65 by the European guidelines on CV disease prevention from the European Society of Cardiology[14], and has been re-calibrated in various European countries to account for differences in mortality rates and risk factor distributions[15,16,17,18]. 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.

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