Several popular standardized risk assessment algorithms used by physicians to calculate a patient’s risk for having a heart attack seriously overestimate the likelihood, according to an article published in Annals of Internal Medicine.
National guidelines recommend that clinicians use objective tools, such as the Framingham risk score, to predict a patient’s risk for cardiovascular disease. An accurate risk assessment is important because this information is used to determine if preventive therapies need to be prescribed. There are several such tools available, including the new American Heart Association (AHA) and American College of Cardiology (ACC) “pooled cohort” risk calculator, which is based on data from the Multi-Ethnic Study of Atherosclerosis, or MESA. Researchers compared the new AHA/ACC risk assessment score with four other commonly used “calculators” to assess their ability to correctly match predicted with observed cardiovascular events. They also sought to explore preventive therapy as a cause of the reported risk overestimation.
The researchers found that four out of the five risk scores tested, including the new AHA/ACC score, significantly overestimated the patient’s risk for cardiovascular events. Medication use did not seem to explain the overestimations. Paul M. Ridker, MD, MPH and Nancy R. Cook, ScD of Brigham & Women’s Hospital, Harvard Medical School in Boston, authored an accompanying editorial that analyzes the findings and addresses how the physician community might respond.
Research: An Analysis of Calibration and Discrimination Among Multiple Cardiovascular Risk Scores in a Modern Multiethnic Cohort, A.P. DeFilippis, R. Young, C.J. Carrubba, J.W. McEvoy, M.J. Budoff, R.S. Blumenthal, R.A. Kronmal, R.L. McClelland, K. Nasir, and M.J. Blaha, Annals of Internal Medicine, doi: 10.7326/M14-1281, published 16 February 2015.
Editorial: Comparing Cardiovascular Risk Prediction Scores, P.M. Ridker, and N.R. Cook, Annals of Internal Medicine, doi: 10.7326/M14-2820, published 16 February 2015.
Source: American College of Physicians