Assessing the severity of cardiovascular disease in 213 088 patients with coronary heart disease: a retrospective cohort study.



Zghebi, Salwa S ORCID: 0000-0002-7978-1094, Mamas, Mamas A ORCID: 0000-0001-9241-8890, Ashcroft, Darren M ORCID: 0000-0002-2958-915X, Rutter, Martin K ORCID: 0000-0001-6380-539X, VanMarwijk, Harm ORCID: 0000-0001-6206-485X, Salisbury, Chris, Mallen, Christian D ORCID: 0000-0002-2677-1028, Chew-Graham, Caroline A, Qureshi, Nadeem ORCID: 0000-0003-4909-0644, Weng, Stephen F
et al (show 6 more authors) (2021) Assessing the severity of cardiovascular disease in 213 088 patients with coronary heart disease: a retrospective cohort study. Open heart, 8 (1). e001498 - ?.

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Abstract

Most current cardiovascular disease (CVD) risk stratification tools are for people without CVD, but very few are for prevalent CVD. In this study, we developed and validated a CVD severity score in people with coronary heart disease (CHD) and evaluated the association between severity and adverse outcomes. Primary and secondary care data for 213 088 people with CHD in 398 practices in England between 2007 and 2017 were used. The cohort was randomly divided into training and validation datasets (80%/20%) for the severity model. Using 20 clinical severity indicators (each assigned a weight=1), baseline and longitudinal CVD severity scores were calculated as the sum of indicators. Adjusted Cox and competing-risk regression models were used to estimate risks for all-cause and cause-specific hospitalisation and mortality. Mean age was 64.5±12.7 years, 46% women, 16% from deprived areas, baseline severity score 1.5±1.2, with higher scores indicating a higher burden of disease. In the training dataset, 138 510 (81%) patients were hospitalised at least once, and 39 944 (23%) patients died. Each 1-unit increase in baseline severity was associated with 41% (95% CI 37% to 45%, area under the receiver operating characteristics (AUROC) curve=0.79) risk for 1 year for all-cause mortality; 59% (95% CI 52% to 67%, AUROC=0.80) for cardiovascular (CV)/diabetes mortality; 27% (95% CI 26% to 28%) for any-cause hospitalisation and 37% (95% CI 36% to 38%) for CV/diabetes hospitalisation. Findings were consistent in the validation dataset. Higher CVD severity score is associated with higher risks for any-cause and cause-specific hospital admissions and mortality in people with CHD. Our reproducible score based on routinely collected data can help practitioners better prioritise management of people with CHD in primary care.

Item Type: Article
Uncontrolled Keywords: Humans, Cardiovascular Diseases, Coronary Disease, Coronary Angiography, Morbidity, Cause of Death, Survival Rate, Risk Assessment, Risk Factors, Retrospective Studies, Follow-Up Studies, Middle Aged, England, Female, Male
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Population Health
Depositing User: Symplectic Admin
Date Deposited: 24 Jun 2021 11:31
Last Modified: 05 Sep 2022 20:10
DOI: 10.1136/openhrt-2020-001498
URI: https://livrepository.liverpool.ac.uk/id/eprint/3127571