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Validation of a Novel Risk Prediction Score for Sudden Cardiac Death in the Framingham Heart Study
Thien Tan Tri Tai Truyen1, Honghuang Lin2, Marco Mathias1
1Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA (T.T.T.T.T., M.M., H.C., K.R., S.S.C.).
Insights
The VFRisk score effectively predicts sudden cardiac death (SCD) in the Framingham Heart Study. This risk prediction score demonstrated good discrimination for SCD events, highlighting its clinical utility.
Area of Science:
- Cardiology
- Epidemiology
- Biostatistics
Background:
- A novel clinical risk score, VFRisk, was previously developed to predict shockable sudden cardiac arrest (SCA).
- The VFRisk score was initially validated in two US west coast communities.
- Its predictive capability for sudden cardiac death (SCD) in the geographically distinct Framingham Heart Study (FHS) was hypothesized.
Purpose of the Study:
- To test the VFRisk score's ability to predict sudden cardiac death (SCD) in the Framingham Heart Study (FHS) cohort.
- To assess the VFRisk score's performance in a new, geographically distinct population.
- To evaluate the clinical utility of the VFRisk score for SCD risk prediction.
Main Methods:
- A nested case-referent study design was employed within the FHS.
- Cases were defined as participants experiencing SCD, with referents randomly selected and frequency-matched.
- The VFRisk score, comprising 12 weighted risk factors, was calculated for all participants.
Main Results:
- The VFRisk score demonstrated good discrimination for SCD in the FHS (C-statistic = 0.71).
- SCD cases exhibited significantly higher VFRisk scores compared to referents (3.8 vs. 1.8, P < 0.001).
- A 1-unit increase in VFRisk score was associated with a 48% increased odds of SCD (OR = 1.48).
Conclusions:
- The VFRisk score successfully predicted sudden cardiac death (SCD) in the Framingham Heart Study.
- The study confirmed the VFRisk score's generalizability to a new population.
- Differences in discrimination may be attributed to the inability to differentiate shockable from non-shockable events in the FHS data.
Background:
We have previously reported a novel clinical risk score (risk prediction score for shockable sudden cardiac arrest [VFRisk]) for the prediction of shockable sudden cardiac arrest, discovered and validated in 2 US west coast communities. We hypothesized that VFRisk predicts sudden cardiac death (SCD) risk in the geographically distinct FHS (Framingham Heart Study).
Methods:
We performed a nested case-referents study in the FHS to test VFRisk. Cases were participants who experienced SCD among the original and offspring FHS cohorts. Referents were randomly selected from FHS participants frequency-matched (ratio of 1:3) to cases on age, sex, cohort, and exam. VFRisk was the sum of 12 risk factors, each multiplied by its respective points.
Results:
Among 312 cases and 935 referents, mean ages were 69.5 and 69.7 years with 70.8% men in both groups. SCD cases had significantly higher prevalence of diabetes, heart failure, stroke, atrial fibrillation, and myocardial infarction compared with the referents group. The VFRisk score was validated with good discrimination (C-statistic, 0.71 [95% CI, 0.66-0.77]) for SCD. Cases had higher VFRisk scores than referents (3.8±2.8 versus 1.8±1.7; P<0.001). A 1-unit increase in VFRisk score was associated with a 48% increase in odds of SCD (odds ratio, 1.48 [95% CI, 1.34-1.64]). The highest VFRisk quartile had 7.8-fold higher odds of SCD than the lowest quartile.
Conclusions:
The VFRisk score successfully predicted SCD in the FHS. The differences in discrimination between the 2 studies could partially be explained by the inability to distinguish shockable versus nonshockable events in the FHS.
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