Agreement among cardiovascular disease risk calculators

Area of Science:

• Cardiology
• Medical Informatics
• Public Health

Background:

• Cardiovascular disease risk calculators are widely recommended by clinical guidelines.
• Limited research exists on the consistency of risk assessment across different calculators.
• Guideline recommendations for calculator use necessitate understanding their comparative performance.

Purpose of the Study:

• To evaluate the consistency and variability in cardiovascular disease risk estimation among commonly used risk calculators.
• To compare risk categorization and absolute risk estimates generated by different calculators for hypothetical patients.
• To assess the implications of calculator variability on clinical decision-making and guideline adherence.

Main Methods:

• A systematic search identified 25 cardiovascular disease risk calculators.
• 128 unique hypothetical patients were generated based on 7 dichotomized risk factors.
• Two clinicians independently assessed each patient using each selected calculator, comparing risk estimates and categories.

Main Results:

• Significant variability was observed in risk categorization, with calculators assigning patients to a mean of 2.2 categories.
• Risk category agreement between calculator pairs was only 67%.
• For the same patient, the highest calculated risk estimate averaged 4.9 times higher than the lowest, irrespective of diabetes status.

Conclusions:

• The choice of cardiovascular disease risk calculator significantly impacts both risk categorization and absolute risk estimates.
• This variability has substantial implications for clinical guidelines that recommend therapies based on specific calculator outputs.
• Standardization or clear guidance on calculator selection is needed to ensure consistent patient management.