| アブストラクト | 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. |
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| 投稿者 | Chung, Ryan; Xu, Zhe; Arnold, Matthew; Stevens, David; Keogh, Ruth; Barrett, Jessica; Harrison, Hannah; Pennells, Lisa; Kim, Lois G; DiAngelantonio, Emanuele; Paige, Ellie; Usher-Smith, Juliet A; Wood, Angela M |
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| 組織名 | British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public;Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.;London School of Hygiene and Tropical Medicine, Faculty of Epidemiology &;Population Health, London, United Kingdom.;Medical Research Council Biostatistics Unit, University of Cambridge, Cambridge,;United Kingdom.;Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary;Care, University of Cambridge, Cambridge, United Kingdom.;National Institute for Health and Care Research Blood and Transplant Research;Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United;Kingdom.;British Heart Foundation Centre of Research Excellence, University of Cambridge,;Cambridge, United Kingdom.;Health Data Research UK Cambridge, Wellcome Genome Campus and University of;Cambridge, Cambridge, United Kingdom.;Health Data Science Research Centre, Human Technopole, Milan, Italy.;National Centre for Epidemiology and Population Health, Australian National;University, Canberra, Australia.;Primary Care Unit, Department of Public Health and Primary Care, University of;Cambridge Centre of Artificial Intelligence in Medicine, Cambridge, United |
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