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Prioritising cardiovascular disease risk assessment to high risk individuals based on primary care records

Published version
Peer-reviewed

Repository DOI


Change log

Authors

Arnold, Matthew 
Stevens, David 
Barrett, Jessica 

Abstract

Objective: To provide quantitative evidence for systematically prioritising individuals for full formal cardiovascular disease (CVD) risk assessment using primary care records with a novel tool (eHEART) with age- and sex- specific risk thresholds.

Methods and Analysis: eHEART was derived using landmark Cox models for incident CVD with repeated measures of conventional CVD risk predictors in 1,642,498 individuals from the Clinical Practice Research Datalink. Using 119,137 individuals from UK Biobank, we modelled the implications of initiating guideline-recommended statin therapy using eHEART with age- and sex-specific prioritisation thresholds corresponding to 5% false negative rates to prioritise adults aged 40-69 years in a population in England for invitation to a formal CVD risk assessment.

Results: Formal CVD risk assessment on all adults would identify 76% and 49% of future CVD events amongst men and women respectively, and 93 (95% CI: 90, 95) men and 279 (95% CI: 259, 297) women would need to be screened (NNS) to prevent one CVD event. In contrast, if eHEART was first used to prioritise individuals for formal CVD risk assessment, we would identify 73% and 47% of future events amongst men and women respectively, and a NNS of 75 (95% CI: 72, 77) men and 162 (95% CI: 150, 172) women. Replacing the age- and sex-specific prioritisation thresholds with a 10% threshold identify around 10% less events.

Conclusions: The use of prioritisation tools with age- and sex-specific thresholds could lead to more efficient CVD assessment programmes with only small reductions in effectiveness at preventing new CVD events.

Description

Acknowledgements: CPRD uses data provided by patients and collected by the NHS as part of their care and support. This work was supported by Health Data Research UK, which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission. This work was performed using resources provided by the Cambridge Service for Data Driven Discovery (CSD3) operated by the University of Cambridge Research Computing Service (www.csd3.cam.ac.uk).


Funder: Chinese Scholarship Council

Keywords

Adult, Male, Humans, Female, Cardiovascular Diseases, England, Risk Assessment, Primary Health Care, Risk Factors

Journal Title

PLoS One

Conference Name

Journal ISSN

1932-6203
1932-6203

Volume Title

18

Publisher

Public Library of Science (PLoS)
Sponsorship
British Heart Foundation (RG/18/13/33946)
National Institute for Health and Care Research (IS-BRC-1215-20014)
Medical Research Council (MR/K014811/1)
British Heart Foundation (FS/18/56/34177D)
MRC (MR/L501566/1)
Department of Health (via National Institute for Health Research (NIHR)) (NIHR203337)
Department of Health (via National Institute for Health Research (NIHR)) (NIHR300861)
British Heart Foundation (None)
British Heart Foundation (None)
British Heart Foundation (FS/18/56/34177)
Engineering and Physical Sciences Research Council (EP/P020259/1)
British Heart Foundation (SP/18/3/33801)