Prioritising cardiovascular disease risk assessment to high risk individuals based on primary care records

Area of Science:

• Cardiovascular Medicine
• Public Health
• Health Informatics

Background:

• Cardiovascular disease (CVD) remains a leading cause of mortality globally.
• Systematic risk assessment is crucial for early detection and prevention of CVD.
• Current risk assessment strategies may benefit from enhanced prioritization tools.

Purpose of the Study:

• To provide quantitative evidence for prioritizing individuals for cardiovascular disease (CVD) risk assessment using the novel eHEART tool.
• To evaluate the effectiveness of age- and sex-specific risk thresholds within the eHEART tool for primary care settings.

Main Methods:

• The eHEART tool was developed using Cox models and data from 1,642,498 individuals in the Clinical Practice Research Datalink.
• Implications for statin therapy initiation were modeled using UK Biobank data (119,137 individuals).
• Age- and sex-specific thresholds were applied to prioritize adults aged 40-69 for CVD risk assessment.

Main Results:

• Prioritization using eHEART identified 73% of future CVD events in men and 47% in women, with a lower number needed to screen (NNS) compared to universal assessment.
• The NNS for eHEART was 75 men and 162 women to prevent one CVD event, versus 93 men and 279 women for universal screening.
• Using a 10% threshold identified approximately 10% fewer events compared to specific thresholds.

Conclusions:

• Prioritization tools like eHEART, with tailored age- and sex-specific thresholds, can enhance the efficiency of CVD assessment programs.
• These tools offer a strategy for more targeted CVD risk management with minimal loss in effectiveness.
• Implementation of eHEART could optimize resource allocation in public health initiatives for CVD prevention.