Validation of the Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) in the EPIC-Norfolk prospective population study.


Type
Article
Change log
Authors
Verweij, Lotte 
Peters, Ron JG 
Scholte Op Reimer, Wilma JM 
Boekholdt, S Matthijs 
Luben, Robert M 
Abstract

BACKGROUND: The Systematic COronary Risk Evaluation - Older Persons (SCORE-OP) algorithm is developed to assess 10-year risk of death due to cardiovascular disease (CVD) in individuals aged ≥65 years. We studied the performance of SCORE-OP in the European Prospective Investigation of Cancer Norfolk (EPIC-Norfolk) prospective population cohort. METHODS: 10-year CVD mortality as predicted by SCORE-OP was compared with observed CVD mortality among individuals in the EPIC-Norfolk cohort. Persons aged 65-79 years without known CVD were included in the analysis. CVD mortality was defined as death due to ischemic heart disease, cardiac failure, cerebrovascular disease, peripheral-artery disease or aortic aneurysm. Predicted 10-year CVD mortality was calculated by the SCORE-OP algorithm, and compared to observed mortality rates. The area under the receiver operator characteristics curve (AUROC) was calculated to evaluate discriminative power. Calibration was evaluated by calculating ratios of predicted vs observed mortality and by Hosmer-Lemeshow tests. RESULTS: A total of 6590 individuals (45.8% men), mean age 70.2 years (standard deviation 3.3) were included. The predicted mortality by SCORE-OP was 9.84% (95% confidence interval (CI) 9.76-9.92) and observed mortality was 10.2% (95% CI 9.52-11.04), ratio 0.96. AUROC was 0.63 (95% CI 0.60-0.65), and X2 was 3.3 (p = 0.92). CONCLUSION: SCORE-OP overall accurately estimates the rate of CVD mortality in a general population aged 65-79 years. However, while calibration is excellent, the discriminative power of the SCORE-OP is limited, and as such cannot be readily implemented in clinical practice for this population.

Description
Keywords
Aged, Cardiovascular disease, Mortality, Primary prevention, Risk prediction, Aged, Algorithms, Cardiovascular Diseases, Cause of Death, Europe, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Risk Assessment, Risk Factors
Journal Title
Int J Cardiol
Conference Name
Journal ISSN
0167-5273
1874-1754
Volume Title
293
Publisher
Elsevier BV
Sponsorship
Medical Research Council (G1000143)
Medical Research Council (MC_UU_12015/1)
Department of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
Medical Research Council (MR/N003284/1)
Medical Research Council (G0401527)