Use and Customization of Risk Scores for Predicting Cardiovascular Events Using Electronic Health Record Data.
Use and Customization of Risk Scores for Predicting Cardiovascular Events Using Electronic Health Record Data.
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DOI：
10.1161/jaha.116.003670
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发表时间：
2017-04-24
影响因子：
5.4
通讯作者：
O'Connor PJ
中科院分区：
文献类型：
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作者：
Wolfson J;Vock DM;Bandyopadhyay S;Kottke T;Vazquez-Benitez G;Johnson P;Adomavicius G;O'Connor PJ
使用Framingham Risk Score(FRS)或美国心脏病学会/美国心脏协会联合队列方程(PCE)基于电子健康数据(EHD)为患者评估风险的临床医生面临4个问题。(1)已发表的应用于EHD收益率的风险评分是否准确地估计了心血管风险？(2)基于长达45岁的数据的FRS风险评估对寻求常规护理的当代患者群体有效吗？(3)PCE是否使FRS过时？(4)使用EHD重新调整风险评分是否提高了风险评估的准确性？数据摘自EHD的84-116名年龄在40岁至79岁之间的成年人，他们在2001年至2011年期间在一家大型医疗保健提供和保险组织接受护理。我们评估了4个风险评分的校准和区分：FRS和PCE的已发表版本，以及通过使用可用EHD的子集改装模型而获得的版本。已发表的FRS得到了很好的校准(校准统计量K=9.1，在风险组中的误校准度在0%到17%之间)，但PCE显示出少量的误校准证据(校准统计量K=43.7，误校准度从9%到31%)。两个模型的辨别能力相似(C指数分别为0.740和0.747)。使用EHD改装已发表的模型并没有显著改善校准或辨别能力。我们的结论是，已发表的心血管风险模型可以成功地应用于EHD来估计心血管风险；FRS仍然有效且不会过时；模型改装并不能显著提高风险估计的准确性。
Clinicians who are using the Framingham Risk Score (FRS) or the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) to estimate risk for their patients based on electronic health data (EHD) face 4 questions. (1) Do published risk scores applied to EHD yield accurate estimates of cardiovascular risk? (2) Are FRS risk estimates, which are based on data that are up to 45 years old, valid for a contemporary patient population seeking routine care? (3) Do the PCE make the FRS obsolete? (4) Does refitting the risk score using EHD improve the accuracy of risk estimates? Data were extracted from the EHD of 84 116 adults aged 40 to 79 years who received care at a large healthcare delivery and insurance organization between 2001 and 2011. We assessed calibration and discrimination for 4 risk scores: published versions of FRS and PCE and versions obtained by refitting models using a subset of the available EHD. The published FRS was well calibrated (calibration statistic K=9.1, miscalibration ranging from 0% to 17% across risk groups), but the PCE displayed modest evidence of miscalibration (calibration statistic K=43.7, miscalibration from 9% to 31%). Discrimination was similar in both models (C‐index=0.740 for FRS, 0.747 for PCE). Refitting the published models using EHD did not substantially improve calibration or discrimination. We conclude that published cardiovascular risk models can be successfully applied to EHD to estimate cardiovascular risk; the FRS remains valid and is not obsolete; and model refitting does not meaningfully improve the accuracy of risk estimates.