Simplifying cardiovascular risk estimation using resting heart rate
Marie Therese Cooney1, Erkki Vartiainen, Tiina Laatikainen
1Department of Cardiology, Adelaide Meath Hospital, Tallaght, Dublin 24, Ireland.
Insights
Elevated resting heart rate (RHR) does not significantly improve cardiovascular disease risk prediction when added to existing complex formulas. However, including RHR in simpler risk assessment models offers a valuable and accessible improvement.
Area of Science:
- Cardiology
- Preventive Medicine
- Biostatistics
Background:
- Elevated resting heart rate (RHR) is an independent cardiovascular (CV) risk factor.
- Current risk estimation systems, like Systematic COronary Risk Evaluation (SCORE), do not incorporate RHR.
Purpose of the Study:
- To develop risk estimation models that include RHR.
- To evaluate the added value of RHR in predicting cardiovascular disease (CVD) mortality.
Main Methods:
- Two risk prediction formulas were derived using data from the National FINRISK study (14,997 men, 15,861 women).
- The first formula included traditional SCORE variables; the second was a simplified model.
- RHR was added as an extra variable to both formulas to assess its impact on discrimination and calibration.
Main Results:
- Adding RHR to the traditional SCORE formula showed only minor improvements in CV disease mortality risk prediction (AUROC, NRI).
- Inclusion of RHR in a simplified formula (age, smoking, gender, BMI) significantly improved risk prediction (AUROC, NRI) and calibration.
- A chart for estimating 10-year fatal CVD risk including RHR was developed.
Conclusions:
- RHR addition does not substantially enhance risk estimation in complex models with lipid and blood pressure data.
- Incorporating RHR into simplified risk assessment systems is beneficial, potentially increasing cost-effectiveness and accessibility.
Aims:
Elevated resting heart rate (RHR) is a known, independent cardiovascular (CV) risk factor, but is not included in risk estimation systems, including Systematic COronary Risk Evaluation (SCORE). We aimed to derive risk estimation systems including RHR as an extra variable and assess the value of this addition.
Methods And Results:
The National FINRISK study (including 14,997 men and 15,861 women) was used to derive two formulas for estimation of 10 year risk of CV disease (CVD) mortality. The first formula contained current SCORE variables-total cholesterol, systolic blood pressure, smoking, age and gender. Inclusion of RHR resulted in only minor improvements in discrimination, based on both area under receiver operating characteristic curve (AUROC, men: 0.840 from 0.838, P = 0.5038; women: 0.87 from 0.865, P = 0.0522) and net reclassification index (NRI). The second, simplified formula contained only, age, smoking, gender, and body mass index. Addition of RHR to this simplified formula resulted in a statistically significant and meaningful improvement in AUROC (men: 0.819 from 0.812, P = 0.037; women: 0.862 from 0.827, P = 0.023) and NRI (0.05). Calibration also improved. A simple chart for estimating 10 year risk of fatal CVD including RHR is presented.
Conclusion:
Addition of RHR to formulas already containing lipid and blood pressure measures does not appreciably improve risk estimation. However, inclusion of RHR in simple systems, which can potentially enhance cost-effectiveness and accessibility of risk estimation, is useful.
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