Performance of Cardiovascular Disease (CVD) Risk Assessment Tools in Clinical Practice - Agreement Between Different...

We aimed to compare performance of three cardiovascular disease (CVD) risk estimation tools; the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction tool, the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ACC/AHA ASCVD) Risk Estimator, and Framingham risk score (FRS) in estimating the risk of fatal and nonfatal cardiovascular events.

We conducted a prospective, observational, hospital-based study involving 200 high-risk study participants, who visited a non-communicable disease clinic in a tertiary care hospital in eastern India. The 10-year CVD risk was estimated using the ACC/AHA ASCVD Risk Estimator, FRS, and the WHO/ISH risk prediction tool. We used kappa statistics to determine agreement among these CVD risk estimators.

The mean (SD) age of study participants was 54.07 (9.15) years, and the majority (63.5%) were males. About 96% of the participants were diabetic, 33.5% were hypertensive, and 16% were current smokers. About 18%, 20.5%, and 0.5% were classified as high-risk using the ACC/AHA ASCVD Risk Estimator, FRS, and WHO/ISH risk tools, respectively. The agreement was moderate between the ASCVD risk estimator and FRS (Kappa 0.541, P < 0.001) and fair between the ASCVD risk Estimator and WHO/ISH (Kappa 0.305, P < 0.001) and between FRS and WHO/ISH (Kappa 0.314, P < 0.001).

A higher level of agreement was found between FRS and ASCVD risk scores compared to the WHO-ISH risk score. The WHO-ISH risk score identified most study participants in the lower-risk category, contrary to the FRS and ASCVD risk scores.