Prediction Charts Research Articles

Nurse-led cardiovascular diseases risk assessment and communication using WHO/ISH risk prediction chart in a tertiary care hospital of North India.

Cardiovascular diseases (CVDs) contribute to most of the potentially preventable burden through early risk assessment. Nurse-led CVD risk assessment is an effective strategy to address the human resource crisis for CVD prevention. An interventional study was conducted in medicine wards of a tertiary care hospital in North India to train nurses in CVD risk assessment and its communication. All bedside nurses (n = 30) of selected wards were enrolled and trained in CVD risk assessment and communication using WHO/ISH risk prediction charts. Once fully trained, each nurse enrolled patients (>40 years of age) from their respective wards to assess and communicate CVD risk. To calculate the reliability of risk assessment, investigator simultaneously assessed CVD risk with nurses. The mean age of nurses was 32.07 ± 6.31 years. The results revealed that training significantly increased the knowledge of nursing personnel (P < 0.001). There was perfect inter-rater reliability agreement (Cohen's k = 0.929) between nurses and investigators while assessing CVD risk. Nurses demonstrated good communication skills. The study concluded that nurses can be trained successfully in CVD risk assessment and communication. The study recommends the task shifting of CVD risk assessment to nurses after providing proper training.

Assessment of cardiovascular risk using WHO CVD risk prediction chart with respect to hypertension status among Indian population: A secondary analysis of National Family Health Survey (2015-16).

Hypertension, is a crucial risk factor for the development of cardiovascular disease (CVD). Studies assessing the risk of developing CVD among high-risk groups like hypertensives is limited. The purpose of this study was to find the distribution of CVD risk with respect to hypertension status among Indian adults. This was a secondary data analysis of NFHS-4 survey data. The distribution of CVD risk among hypertensive participants using 2019 WHO CVD risk prediction charts was compared with normotensive participants among women aged 40-49 years and men in the age group of 40-54 years. The proportion of hypertension was higher among women who consumed alcohol (31.5%) than those who did not (24.3%). The proportion of hypertensives increased with increasing BMI, with maximum proportion among obese women (37.3%). Among women, majority (95.7%) had low CVD risk (<5%) while 4.2% had 5% to <10% CVD risk, and only 0.1% had >10% risk. Among men, those with low CVD risk (<5%) was 65%, those with 5% to <10% CVD risk was 32.3%, 10% to <20% was 2.7%, and a meagre 0.03% had 20 to <30% risk. In the current study, prevalence of hypertension was seen to be increasing with age and was higher in urban residents than rural among both men and women. Both high blood pressure reading during the survey and self-reported hypertension was found to be higher among richest wealth index category. Although risk was higher among hypertensives, self-reported hypertensives who had their blood pressure controlled, had risk similar to normotensives indicating the importance of management of hypertension.

A Ten-year Risk Assessment Study of Cardiovascular Events Among Adults Visiting a Tertiary Care Institution in Northern India

Introduction: Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels, including Myocardial Infarction (MI) and stroke. Risk factors included are both modifiable and non modifiable, like age, sex, blood pressure, smoking status, total blood cholesterol and presence or absence of diabetes mellitus. In the above background it is important to find out the risk of CVDs among patients visiting Urban Health Training Centre (UHTC) of a tertiary care institute. Early detection of risk probability will alert them to modify the involved risk factors to avert the CVDs. Aim: To find out the risk of CVDs among adult patients in a duration of ten years, who visited the Outpatient Department (OPD) of UHTC, using World Health Organisation/International Society of Hypertension (WHO/ISH) risk prediction Chart. Materials and Methods: A cross-sectional study was conducted in the Department of Community Medicine, of a tertiary care institution in Northern India, from August 2017 to January 2018. A total of 400 subjects were enrolled. Data were collected using the WHO/ISH ten years risk prediction chart. Chi-square test was applied and level of significance were obtained at p-value &lt;0.05. Results: Majority (58.75%) of the population belonged to the young adult age group (30-50 years). There were 216 males and 184 females. Overall, 7.75% people were diabetic, and 11.25% were smokers. Majority (69.5%) of the people had less than 10% risk for CVD, and 5.75% people had ≥40% risk. With respect to total serum cholesterol, 9% had high level of cholesterol. Statistically significant association was observed between Socio-economic Status (SES) (modified Kuppuswami scale) and cardiovascular event (p&lt;0.001). Middle income group were more at risk compared to others (p&lt;0.001). Conclusion: Middle income group people and young age group had more risk of developing CVDs in future, compared to low- income group and other age groups. So, an early intervention in the lifestyle may avoid CVDs. Also, this study gives way for further research on the weightage of the individual risk factors for CVDs.

Task shifting of cardiovascular disease risk assessment to Anganwadi Worker in Northern India.

Background:Cardiovascular diseases (CVDs) cause significant morbidity and mortality worldwide. Task shifting in various forms has been adopted extensively around the world in an effort to increase access to CVD risk assessment for early identification of high-risk individuals. Present study explored the feasibility of task shifting of CVD risk assessment by anganwadi workers (AWWs).Method:An operational study was carried out with the objective to develop the knowledge and skill of AWWs in CVD risk assessment. The study was carried out in the anganwadi centres of Northern India. A total of 40 AWWs were enrolled by using purposive sampling technique. They were trained in CVD risk assessment till they fully developed the skill. These trained AWW carried out CVD risk assessment among subjects aged ≥40 years. Cohen Kappa was used to determine the reliability of risk assessment by AWWs. Communication skills of AWWs were measured by using a standardized communication checklist.Result:Result revealed high interrater reliability of risk scores generated by AWWs and researcher (k = 0.91). Majority of the AWWs (87%) demonstrated good communication skills.Conclusion:Study concludes that AWWs can be trained in CVD risk assessment using WHO/ISH risk prediction charts. With proper training and supervision, the task of the CVD risk assessment can be shifted to AWWs.

Cardiovascular Disease Risk Stratification in Wrist Wearable Devices and e-Health App Users: A Large-Scale Retrospective Study.

Introduction: Wearable devices, including smart wristbands and watches, are often used with e-health applications (apps). The users' characteristics of wrist wearable devices currently lack description, and the cardiovascular disease (CVD) high-risk rate of users remains unknown. Purpose: This study aimed to (1) describe the basic characteristics and habits of users of the "Amazfit Health" app and Huami wrist wearable devices and (2) analyze the proportion and define the population characteristics of users with a high risk of developing CVD. Subjects and Methods: This study included users >18 years of age, residing in mainland China, using the "Amazfit Health" app and Huami wearable devices. Devices data and users' self-reported information were collected in the app. The risk stratification was based on WHO/ISH cardiovascular risk prediction charts for the Western Pacific Region. Subjects with CVD history, total cholesterol ≥8 mmol/L, or ≥10% predicted CVD risk and those with <10% predicted CVD risk were considered to be at high and low risk of developing CVD, respectively. Results: Data were obtained from 80,098 (total users) and 10,866 users (subjects) for risk stratification. The age of the total users and subjects were 45.6 ± 15.4 and 50.7 ± 14.0 years, respectively. The number of male and female users was 50,024, and 30,074 in total users, and 7,284, and 3,582 in subjects, respectively. The body mass index of total users and subjects was 24.0 ± 4.6 kg/m2 and 24.6 ± 3.8 kg/m2, respectively. By classifying users' residences into first-tier cities, municipalities and provincial capitals, and other areas, the numbers of total users were 20,179, 28,213, and 31,137, and subjects were 2,587, 3,966, and 4,269, respectively. The number of subjects with high CVD risk was 1,161, accounting for 10.7% of all subjects. Conclusions: Users with high CVD risk only accounted for a small proportion of the population of wearable devices users.

Forecast methane content in coal seams from -250 m to -400 m of Mong Duong coal mine

Methane is considered to be the most dangerous gas in underground mining coal mines, and is particularl especially dangerous for mines ranked high in methane such as Mao Khe, Quang Hanh, Khe Cham, Mong Duong.... Mong Duong coal mine is tending to exploit down to -400 m and will zone mining areas in 2022, which means that the methane content in the coal seams also tends to increase with the mining depth, especially for the level below -250 m of Mong Duong coal mine, where has relatively complicated geological conditions and very limited methane exploration works. In order to have effective preventive measures to avoid methane gas explosions, the paper has made predictions for the methane storage capacity of Mong Duong coal mine at different depths. The paper has built the prediction chart of methane concentration when exploiting deeply based on the least squares method of Excel software. From there, the forecast data of methane content in coal seams from the current mining depth to -400 m level of Mong Duong coal mine. The forecast results of the methane content in coal seams at -400 level of Mong Duong coal mine are markedly increased compared to the current exploitation level, especially at I12 with increased methane content in the coal seam, maximum reached 4.5828m3/T.kc. The methane content in reservoir I-12 is shown by the equation y = 0.0132x-0.6983. The results of the prediction of methane content make it easier to proactively plan to eliminate methane incidents and ensure safety in underground coal mining.

A New Production Forecasting Method of the Multifractured Horizontal Wells Based on Cluster Analysis

The seepage mechanism of multifractured horizontal wells is complex in tight reservoirs, which make that the production is very difficult to forecast. This article put forward a new way called the developed clustering analysis to forecast well production which is based on the practical production data of 10 multifractured horizontal wells. This method first uses the information analysis method to obtain the weight of the influencing factors of horizontal well production and normalizes the influencing factors of production. Second, the feature matrix is constructed by combining the weight of each factor, and the distance between the feature matrix of different production wells and the optimal feature matrix is calculated. Finally, the relationship curve between distance and production is plotted, and the production chart of the block is obtained. Taking 9 multifractured horizontal wells in the tight reservoir as an example, the production prediction chart of the block is calculated. At the same time, the production data of the 10th well are used to verify the production chart of the block. The results show that the horizontal well production has a high fitting relationship with the distance. The error between the new well production predicted by the chart and the actual production is 4.7%, which meets the requirements of the field error. The model was also used in a reservoir with 154 wells and also verified the accuracy of the model. The prediction method proposed in this paper can accurately predict the production of volume fractured horizontal wells in the experimental area and provide certain guiding significance for the development and adjustment of tight reservoirs.

Non-invasive risk prediction based on right ventricular function in patients with pulmonary arterial hypertension

Abstract Background Individual risk assessment in patients with pulmonary arterial hypertension (PAH) is fundamental to improve their outcome. Although right ventricular (RV) dysfunction is a major determinant of outcome in PAH, echocardiographic measures of RV function are poorly represented by current risk models. Objective The objective of this study was to identify echocardiographic measures of RV function, which are associated with adverse outcome and to develop a non-invasive, echocardiography-based risk score for PAH patients. Methods In 254 patients with PAH we analyzed functional status, laboratory results, pulmonary function and echocardiographic measures. Echocardiographic measures comprised RV chamber diameters, right atrial area, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), 2D RV strain and pericardial effusion. We used Cox regression models to assess the association with the composite endpoint of 5-year all-cause death or lung transplantation. The analyses included a conventional model using only guideline-recommended variables and a model adding significant echocardiographic measures. Based on the final multivariable model a point risk score was derived, indicating the association with the primary outcome. Results Median age was 65.5 years, 33.9% were females. During a median follow-up time of 4.18 years 74 patients died (n=63) or underwent lung transplantation (n=11). In univariable analyses low systolic blood pressure (Hazard ratio [HR] 0.99, 95% Confidence Interval [CI] 0.98,1.00), NYHA functional class IV (HR 3.23, 95% CI 1.48,7.07), 6-minute walk distance (HR 1.00, 95% CI 1.00,1.00), NT-proBNP concentrations (HR 1.00, 95% CI 1.00,1.00), renal impairment (HR 0.99, 95% CI 0.98,1.00), reduced diffusion capacity for carbon monoxide (HR 0.99, 95% CI 0.98,1.00), reduced TAPSE (HR 0.90, 95% CI 0.85,0.96) and reduced FAC (HR 0.97, 95% CI 0.94,1.00) were associated with the endpoint. A multivariable, conventional risk model, including NYHA functional class, 6-minute walk distance, NT-proBNP concentrations, pericardial effusion and right atrial area, resulted in a C-Index of 0.539. Adding TAPSE and FAC to this model improved the performance significantly (C-index 0.639, p-value 0.017). This model was translated to a 12-point score with the highest weighting assigned to TAPSE, FAC, pericardial effusion and 6-minute walk distance (Figure). Conclusion An easily applicable score integrating non-invasive, echocardiographic parameters of RV function improves prediction of adverse outcome in PAH patients. Funding Acknowledgement Type of funding sources: None. Risk prediction chart

Comparison of traditional versus artificial intelligence based coronary artery disease risk prediction scores in young patients with acute coronary syndrome

Abstract Background Ever since the concept of preventive cardiology has come into vogue, several risk identification models have come up which combine several risk factors to create a risk prediction score for occurrence of cardiovascular (CV) event. While carrying a proven validation in Western population, none of the risk prediction model has been satisfactorily evaluated in Indians especially young &amp;lt;40 years old. Objectives To compare Artificial Intelligence based novel risk score with traditional risk scores in young (less than 40 years age) patients presenting with acute coronary syndrome (ACS) and to estimate the relative efficacy of different coronary artery disease (CAD) risk scores in young Indian Patients. Design Single center, Observational, Non-interventional study. Participants Cohort of Patients more than 20 but less than 40 years old with ACS in the department of Cardiology from 1st January 2019 to 31st October 2019. Methods 314 young patients [mean age 36.14±4.17 years] presenting with acute coronary syndrome (ACS) were enrolled. The three clinically most pertinent risk assessment models [Framingham Risk score (FRS), World Health Organization risk prediction charts (WHO/ISH), and QRISK3 scores] and Artificial Intelligence based novel risk score (AICVD) were applied on day 1 of presentation, and tried to see whether one risk score versus other risk score could have predicted the event earlier had we applied it before the occurrence of ACS. Risk factors considered included those already in traditional scoring systems and new risk factors (diet, alcohol, tobacco, dyslipidemia, physical activity, family history of heart disease, history of heart disease, heart rate, respiratory rate, chronic heart symptoms and psychological stress). Results WHO/ISH provided the lowest high risk estimate with only 1 (0.9%) patient estimated to be having &amp;gt;20% 10-year risk. The FRS estimated high risk (&amp;gt;20% 10-year risk) in 3 (1%) patients. The QRISK3 estimated high risk (&amp;gt;10% 10-year risk) in 20 (6.5%) patient. In comparison, AICVD risk prediction model stood tall by identifying 73 (23.2%) patients as high risk and 62.74% patients as more than moderate risk for having CV events at 7 years (p&amp;lt;0.001). Conclusion Perhaps, this is the first study which has compared artificial intelligence based novel risk prediction model with the three most commonly applied models, in the young Indian patients. We found that a cohort of young Indian patients presenting with ACS, when studied retrospectively, was identified as “high risk” most likely by AICVD risk prediction model rather than the traditional counterparts. The WHO/ISH risk prediction charts and FRS were the poorest predictors. Performance of QRISK3 score also remained less than satisfactory. These findings suggested that AICVD risk prediction model is a promising tool to assess for CV risk in Indian population. Funding Acknowledgement Type of funding sources: None. Predictability of risk prediction models

Health Promoting Behaviors and Risk of Cardiovascular Events among Patients with Cardiovascular Diseases

BACKGROUND: Engagement in health-promoting behaviors (HPB) among patients with cardiovascular diseases (CVD) is important, particularly for the high-and-very-high-risk group. However, information concerning HPB and risk of cardiovascular events among patients with CVD is limited. AIM: This study aimed to explore HPB and risk of cardiovascular events among patients with CVD. METHODS: A cross-sectional quantitative study was conducted among adults with confirmed CVD (n = 167) using multistage cluster sampling. Health-Promoting Lifestyle Profile 2 and World Health Organization/International Society of Hypertension Risk Prediction Chart were used for measuring HPB and cardiovascular risk levels. Data were analyzed using Pearson correlation, one-way ANOVA and multiple linear regression tests. RESULTS: Women, marriage, low income, and hypertension dominated with 60 years as mean age. Among the subscales of HPB, interpersonal relationship had the highest score while physical activity in the poorest score and almost half of the respondents had a low-risk of cardiovascular events. There was a significant correlation between the nutrition subscale and cardiovascular risk levels and it showed significant difference between low-and high/ very- high-risk groups of cardiovascular events. Although the risk of cardiovascular events did not demonstrate prediction of HPB, age (β _= 0.250; CI = 0.001–0.013), educational level (β _= 0.200; CI = 0.005–0.107), presence of diabetes (β _= 0.183; CI = 0.013–0.286), and smoking (β _= –0.195; CI = –0.372–[–0.005]) explained 20.7% of the HPB variance. CONCLUSION: Therefore, the authorities of stakeholders need to consider that a tailor-made health-promoting program should be proposed particularly to increase physical activity and promotes healthy nutrition among patients with CVD. Furthermore, considering special needs among patients with CVD are crucial to support them within their cultural perspective.

Comparison of Cardiovascular Risk Estimation Tools in Thai Hospital Employees

OBJECTIVES: To compare cardiovascular disease (CVD) risks estimated by various estimators, we collected and analyzed the annual health checkup data of nonphysician hospital employees (NPHEs) in 5 private hospitals in Thailand in 2018. MATERIALS AND METHODS: This cross-sectional study employed five commonly used CVD risk calculators Thai Cardiovascular (CV) Risk score, modified Coronary Risk Chart (mCRC), Systematic Coronary Risk Evaluation (SCORE) chart, World Health Organization-Southeast Asian Region B (WHO SEAR B) risk prediction chart, and atherosclerotic cardiovascular disease (ASCVD) risk estimator plus) to compare risk levels estimated by each method. Statistical analysis was conducted using R code and STATA. RESULTS: Among 7,286 eligible NPHEs invited to join, 3,687 consented to join. A total of 2,907 subjects were included in this study after excluding those with inadequate data and those with existing CVD. The majority (84.7%) of subjects were female and 75.3% of subjects were in the 30-59 years’ age group. More than half (64.6%) had normal Body Mass Index (BMI). A small proportion had pre-existing hypertension (16.4%), diabetes mellitus (7.9%) and very few reported smoking behavior (5.1%) while a quarter (24.2%) reported regular alcohol use and 60.6% reported sedentary life. Pairwise comparison of future 10-year CVD risks between Thai CV Risk Score and (i) mCRC, (ii) European SCORE, (iii) WHO SEAR B risk chart and, (iv) ASCVD Risk Estimator Plus showed significant agreement of 94.15%, 98.25%, 97.80%, and 98.83% respectively, all with p &lt; 0.001. Comparing results of Thai CV Risk Score when lipid profiles was used and not used also revealed high agreement (88.72%), p &lt; 0.001. Subgroup comparison among those with moderate to high risks, agreement between Thai CV Risk Score with m-CRC, European SCORE, WHO SEAR-B and ASCVD Risk Estimator Plus dropped dramatically to 47.1%, 78.6%, 20.0%, and 41.7% respectively. CONCLUSION: This study shows significant agreement between the Thai CV Risk Score with lipid profiles and mCRC, European SCORE Chart, WHO SEAR B, ASCVD Risk Estimator Plus and Thai CV Risk Score without lipid profiles. The Thai CV Risk Score could numerically detect more persons with moderate or high cardiovascular risk than other risk calculators. Clinical recommendation for those with moderate or even low risk should be made carefully, taking into account that the patient might actually be at a higher risk level.

Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools.

Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors.Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences.Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m2 (p = 0.815).Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.

Developing Non-Laboratory Cardiovascular Risk Assessment Charts and Validating Laboratory and Non-Laboratory-Based Models.

Background:Developing simplified risk assessment model based on non-laboratory risk factors that could determine cardiovascular risk as accurately as laboratory-based one can be valuable, particularly in developing countries where there are limited resources.Objective:To develop a simplified non-laboratory cardiovascular disease risk assessment chart based on previously reported laboratory-based chart and evaluate internal and external validation, and recalibration of both risk models to assess the performance of risk scoring tools in other population.Methods:A 10-year non-laboratory-based risk prediction chart was developed for fatal and non-fatal CVD using Cox Proportional Hazard regression. Data from the Isfahan Cohort Study (ICS), a population-based study among 6504 adults aged ≥ 35 years, followed-up for at least ten years was used for the non-laboratory-based model derivation. Participants were followed up until the occurrence of CVD events. Tehran Lipid and Glucose Study (TLGS) data was used to evaluate the external validity of both non-laboratory and laboratory risk assessment models in other populations rather than one used in the model derivation.Results:The discrimination and calibration analysis of the non-laboratory model showed the following values of Harrell’s C: 0.73 (95% CI 0.71–0.74), and Nam-D’Agostino χ2:11.01 (p = 0.27), respectively. The non-laboratory model was in agreement and classified high risk and low risk patients as accurately as the laboratory one. Both non-laboratory and laboratory risk prediction models showed good discrimination in the external validation, with Harrell’s C of 0.77 (95% CI 0.75–0.78) and 0.78 (95% CI 0.76–0.79), respectively.Conclusions:Our simplified risk assessment model based on non-laboratory risk factors could determine cardiovascular risk as accurately as laboratory-based one. This approach can provide simple risk assessment tool where laboratory testing is unavailable, inconvenient, and costly.

WHO/International Society of Hypertension risk prediction charts versus the UK Prospective Diabetes Study risk engine for cardiovascular risk assessment among patients with type 2 diabetes: a comparative study

BackgroundPatients with type 2 diabetes are at increased risk of developing cardiovascular diseases, and assessment of cardiac risk is important for preventive strategies. We compared the performance of two cardiac assessment tools to predict 10-year cardiovascular risk. MethodsThis was a retrospective study of patients with type 2 diabetes who attended two primary-health-care centres in the Gaza Strip from Sept 15 to Nov 15, 2019. We excluded patients who had any existing cardiovascular disease. 10-year cardiovascular risk assessment was done with two risk assessment tools: the WHO/International Society of Hypertension (WHO/ISH) risk prediction charts and the UK Prospective Diabetes Study (UKPDS) risk engine. We also assessed the need for prescribing statins based on the documented risk. FindingsOf 350 patients assessed, 200 were eligible for the study. WHO/ISH charts classified 135 (68%) patients as being at low of cardiac events and the UKPDS risk engine classified 100 (50%). WHO/ISH assigned 40 (20%) people to the low to moderate 10-year risk category compared with 52 (26%) assigned by the UKPDS risk engine. Agreement between the two tools was poor (p=0·01). 12 (6%) patients who were classified as being at very low 10-year cardiac risk by WHO/ISH were classified as being at very high risk when assessed by the UKPDS risk engine. Furthermore, 150 (75%) of individuals who were categorised as having low cardiac risk by WHO/ISH had higher LDL-cholesterol concentrations than the therapeutic target of 100 mg/dL. Meanwhile, the UKPD risk engine, which uses a higher number of parameters for assessment, identified these individuals as having moderate to high risk. Based on risk documented in the medical records, 33 patients needed statin therapy of whom 12 (36%) patients were receiving this treatment. Among the remaining 167 patients who did not need statin therapy, treatment was prescribed for 57 (34%). InterpretationThere is a significant discrepancy between the WHO/ISH risk charts and the UKPDS risk engine in assigning cardiac risk. Sensitivity in identifying patients with treatable levels of LDL cholesterol and diastolic blood pressure was low for both tools. Furthermore, a lack of clear local protocols led to incorrect or unnecessary prescribing. This study showed that there is a need to reconsider the use of assessment tools either by adding a new tool or by improving assessments with the current tools. FundingNone.

Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study.

Introduction and objectivesThere are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans.MethodWe selected 40–64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007–2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017.ResultsOf 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10–19%, 20%-29%, 30–39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001).ConclusionsWHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.

Ten-years cardiovascular risk among Bangladeshi population using non-laboratory-based risk chart of the World Health Organization: Findings from a nationally representative survey.

The World Health Organization (WHO) has recently developed a non-laboratory based cardiovascular disease (CVD) risk chart considering the parameters age, sex, current smoking status, systolic blood pressure, and body mass index. Using the chart, we estimated the 10-years CVD risk among the Bangladeshi population aged 40-74 years. We analyzed data from a nationally representative survey conducted in 2018-19. The survey enrolled participants from 82 clusters (57 rural, 15 non-slum urban, and 10 slums) selected by multistage cluster sampling. Using the non-laboratory-based CVD risk chart of the World Health Organization (WHO), we categorized the participants into 5 risk groups: very low (<5%), low (5% to <10%), moderate (10% to <20%), high (20% to <30%) and very high (> = 30%) risk. We performed descriptive analyses to report the distribution of CVD risk and carried out univariable and multivariable logistic regression to identify factors associated with elevated CVD risk (> = 10% CVD risk). Of the 7,381 participants, 46.0% were female. The median age (IQR) was 59.0 (48.0-64.7) years. Overall, the prevalence of very low, low, moderate, high, and very high CVD risk was 34.7%, 37.8%, 25.9%, 1.6%, and 0.1%, respectively. Elevated CVD risk (> = 10%) was associated with poor education, currently unmarried, insufficient physical inactivity, smokeless tobacco use, and self-reported diabetes in both sexes, higher household income, and higher sedentary time among males, and slum-dwelling and non-Muslim religions among females. One in every four Bangladeshi adults had elevated levels of CVD risk, and males are at higher risk of occurring CVD events. Non-laboratory-based risk prediction charts can be effectively used in low resource settings. The government of Bangladesh and other developing countries should train the primary health care workers on the use of WHO non-laboratory-based CVD risk charts, especially in settings where laboratory tests are not available.

Implementation of simple additive weighting methods and non-linier trend methods in mapping of flood protected areas: A case study sub-DAS Bengkulu Hilir

This research aims to build a geographic information system that can map the level of flood-prone areas around Sub-DAS Bengkulu. To determine the flood prone areas are used four (4) parameters i.e. riverbank, high ground class, rainfall and settlement using Simple Additive Weighting method and using Trend Non Linier forecasting method. The resulting outer area of the flood map is calculated from The Simple Additive weightingmethod. For five (5) years, from 2014 – 2018 there are 267 data entering intermediate clustering , 477 of data entering low clustering and the latter there are 35 data that enters high clustering . In addition, there is also an external result of prediction Chart of the highest Trend Non Linier in 2021 of 2.3809, in 2022 for 3.14841, in 2023 for 4.04413, in 2024 for 5.06803, and in 2025 for 6.22014.

Assessment of Cardiovascular Risk for Prevention and Control of Cardiovascular Disease in Ghana’s Northern Region A Cross-sectional Study of 4 Rural Districts using World Health Organization / International Society of Hypertension (WHO/ISH) Risk Prediction Charts

Ghana is experiencing an increase in cardiovascular (CVD) -related mortality with poor rural communities suffering greater complications and premature deaths. The point of this exploratory research is to evaluate the prevalence of CVD risk factors and to calculate the cardiovascular risk among adults aged &amp;gt; 40 years in Ghana&amp;rsquo;s Northern Region. A cross-sectional study was performed with 536 subjects. A pre-tested questionnaire, anthropometric measurements, and standardized WHO/ISH risk prediction charts assessed for 10-year risk of a fatal or non-fatal major cardiovascular event according to age, sex, blood pressure, smoking status, and diabetes mellitus status. Low, moderate and high CVD prevalence risk in females was 88.4%, 7.1%, and 4.5% while in males the prevalence was 91.3%, 5.8%, and 2.9%, respectively. Hypertension was noted as a clinically significant risk factor with females at 37.3% versus males at 32%. The 10-year risk of a fatal or non-fatal cardiovascular event was statistically significant for females according to age group. A moderate to high CVD risk of a fatal or non-fatal cardiovascular event was found in 10.4% of subjects. Notable CVD risk factors included a high prevalence of hypertension. Decentralizing care to local village healthcare facilities is one way to tackle cardiovascular risk reduction. Task shifting of primary care duties from physicians to nurses in terms of cardiovascular (CV) risk assessment and management of uncomplicated CV risk factors is a potential solution to the acute shortage of trained health staffs for the control and prevention of CVD in Northern Ghana.

Assessment of ten-year risk of cardiovascular event using WHO/ISH risk prediction chart among adults in a tertiary care hospital in Puducherry, India

Context: The changing trends have revealed that cardiovascular disease (CVD) has evolved as prime cause of mortality globally, and predicting this prior is of utmost interest in patient management. Objective: To assess the ten-year risk of fatal or non-fatal cardiovascular event using World Health Organization/ International Society of Hypertension (WHO/ISH) risk prediction chart among adults. Material and methods: A cross sectional study was conducted among 226 general medicine Outpatient Department (OPD) attendees of a tertiary care hospital. Their risk of encountering a major cardiovascular event such as myocardial infarction or stroke ten year later was assessed using the WHO/ISH risk prediction charts. Appropriate tests of significance were employed. Results: Among 226 study subjects, 174 (76.9%) at low risk, 36 (15.9%) at moderate risk and 16 (7.0%) were at high risk of developing major cardiovascular event in the next ten years. Risk factors such age above 50 years, male gender, presence of hypertension or diabetes and smoking were found to be significantly associated with increased risk of the predicted major cardiovascular event. Conclusions: WHO/ISH chart is a useful tool in identifying individuals at high-risk of cardiovascular disease (CVD) and could help in planning appropriate strategies to mitigate the estimated CVD burden in future.

Predictive Control Charts (PCC): A Bayesian approach in online monitoring of short runs

Performing online monitoring for short horizon data is a challenging, though cost effective benefit. Self-starting methods attempt to address this issue adopting a hybrid scheme that executes calibration and monitoring simultaneously. In this work, we propose a Bayesian alternative that will utilize prior information and possible historical data (via power priors), offering a head-start in online monitoring, putting emphasis on outlier detection. For cases of complete prior ignorance, the objective Bayesian version will be provided. Charting will be based on the predictive distribution and the methodological framework will be derived in a general way, to facilitate discrete and continuous data from any distribution that belongs to the regular exponential family (with Normal, Poisson and Binomial being the most representative). Being in the Bayesian arena, we will be able to not only perform process monitoring, but also draw online inference regarding the unknown process parameter(s). An extended simulation study will evaluate the proposed methodology against frequentist based competitors and it will cover topics regarding prior sensitivity and model misspecification robustness. A continuous and a discrete real data set will illustrate its use in practice. Technical details, algorithms, guidelines on prior elicitation and R-codes are provided in appendices and supplementary material. Short production runs and online phase I monitoring are among the best candidates to benefit from the developed methodology.