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An R-Based Landscape Validation of a Competing Risk Model

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External Validation of the 2023 Australian Cardiovascular Risk Calculator.

Grace Barwick¹, Stephen Hancock², Shu Ren¹

¹School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia.

Heart, Lung & Circulation

|December 17, 2025

Summary

This summary is machine-generated.

The 2023 Australian Cardiovascular Disease Risk Calculator shows modest improvements, particularly in positive likelihood ratios, over the 2012 version. However, the older calculator remains useful for specific groups, necessitating further validation of the new tool.

Keywords:

Cardiovascular disease External validation Predictive performance Risk prediction model Risk stratification

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Area of Science:

Cardiology
Preventive Medicine
Health Informatics

Background:

The Australian Cardiovascular Disease Risk Calculator estimates 5-year CVD risk.
A new version was released in July 2023, aiming to improve predictive performance over the 2012 predecessor.
External validation was conducted using the Hunter Community Study (HCS) cohort.

Purpose of the Study:

Compare the predictive performance of the 2023 and 2012 Australian CVD risk calculators.
Assess discrimination, calibration, sensitivity, and specificity of both calculator versions.
Evaluate the clinical utility of the updated CVD risk assessment tool.

Main Methods:

External validation of two Australian CVD risk calculators.
Comparison of predicted vs. observed 5-year CVD events in the HCS cohort (aged 55-85).
Analysis of discrimination (AUROC), calibration (O/E ratio), sensitivity, and specificity.

Main Results:

Both calculators demonstrated similar discrimination (AUROC 0.71).
The 2023 calculator improved sensitivity in males and specificity in females.
Calibration varied: overprediction in males (O/E 0.57) but better calibration in females (O/E 1.02) with the 2023 version.

Conclusions:

The 2023 calculator offers some predictive improvements, notably positive likelihood ratios.
The 2012 calculator retains value for specific populations and purposes.
Further external validation using a larger, nationwide cohort is recommended for the 2023 Australian CVD Risk Calculator.