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Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and
Ralph K Akyea1, Jo Leonardi-Bee2, Folkert W Asselbergs3,4
1Division of Primary Care, University of Nottingham, Nottingham, UK mszrka@nottingham.ac.uk.
Insights
This review evaluates prognostic models for cardiovascular disease (CVD) recurrence in adults with established CVD. Current models are inadequate for secondary prevention, highlighting the need for better risk stratification tools.
Area of Science:
- Cardiology
- Epidemiology
- Medical Informatics
Background:
- Cardiovascular disease (CVD) is a leading global cause of death.
- Improved survival post-CVD necessitates better secondary prevention strategies.
- Existing risk stratification models for established CVD patients are insufficient.
Purpose of the Study:
- To systematically review multivariable prognostic models for CVD recurrence or major adverse cardiovascular events (MACE) in adults with diagnosed CVD.
- To identify and evaluate existing models for their utility in secondary CVD prevention.
Main Methods:
- Systematic literature search of multiple bibliographic databases (MEDLINE, EMBASE, PsycINFO, Web of Science) up to April 2020.
- Inclusion of studies deriving or validating multivariable models for adults (≥16 years) with established CVD and MACE outcomes (CHD, stroke, PAD, HF, CVD mortality).
- Risk of bias assessment using PROBAST and narrative summary of models; meta-analysis for predictive performance if feasible.
Main Results:
- The review will summarize findings from eligible multivariable prognostic models.
- Predictive performance of models will be assessed and potentially pooled using meta-analysis.
- Identification of strengths and limitations of current CVD risk models.
Conclusions:
- There is a critical need for improved multivariable prognostic models for CVD risk stratification.
- Effective models are essential for personalized secondary prevention strategies in CVD survivors.
- This systematic review will inform the development and application of better CVD risk prediction tools.
Introduction:
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models for stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis.
Methods And Analysis:
Bibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. A hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias ASsessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity.
Ethics And Dissemination:
Ethics approval is not required. The results of this study will be submitted to relevant conferences for presentation and a peer-reviewed journal for publication.
Prospero Registration Number:
CRD42019149111.
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