| アブストラクト | AIMS: Reliably quantifying event rates in secondary prevention could aid clinical decision-making, including quantifying potential risk reductions of novel, and sometimes expensive, add-on therapies. We aimed to assess whether the SMART risk prediction model performs well in a real-world setting. METHODS AND RESULTS: We conducted a historical open cohort study using UK primary care data from the Clinical Practice Research Datalink (2000-2017) diagnosed with coronary, cerebrovascular, peripheral, and/or aortic atherosclerotic cardiovascular disease (ASCVD). Analyses were undertaken separately for cohorts with established (>/=6 months) vs. newly diagnosed ASCVD. The outcome was first post-cohort entry occurrence of myocardial infarction, stroke, or cardiovascular death. Among the cohort with established ASCVD [n = 244 578, 62.1% male, median age 67.3 years, interquartile range (IQR) 59.2-74.0], the calibration and discrimination achieved by the SMART model was not dissimilar to performance at internal validation [Harrell's c-statistic = 0.639, 95% confidence interval (CI) 0.636-0.642, compared with 0.675, 0.642-0.708]. Decision curve analysis indicated that the model outperformed treat all and treat none strategies in the clinically relevant 20-60% predicted risk range. Consistent findings were observed in sensitivity analyses, including complete case analysis (n = 182 482; c = 0.624, 95% CI 0.620-0.627). Among the cohort with newly diagnosed ASCVD (n = 136 445; 61.0% male; median age 66.0 years, IQR 57.7-73.2), model performance was weaker with more exaggerated risk under-prediction and a c-statistic of 0.559, 95% CI 0.556-0.562. CONCLUSIONS: The performance of the SMART model in this validation cohort demonstrates its potential utility in routine healthcare settings in guiding both population and individual-level decision-making for secondary prevention patients. |
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| 投稿日 | 2021/6/24 |
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| 投稿者 | McKay, Ailsa J; Gunn, Laura H; Ference, Brian A; Dorresteijn, Jannick A N; Berkelmans, Gijs F N; Visseren, Frank L J; Ray, Kausik K |
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| ジャーナル名 | European journal of preventive cardiology |
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| 組織名 | Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care;and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK.;Department of Public Health Sciences and School of Data Science, University of;North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA.;Department of Primary Care and Public Health, School of Public Health, Imperial;College London, St Dunstan's Road, London W6 8RP, UK.;Centre for Naturally Randomized Trials, University of Cambridge, 2 Worts';Causeway, Cambridge CB1 8RN, UK.;Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500,;3508 GA Utrecht, The Netherlands. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34160035/ |
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