A Simple Community-Based Risk-Prediction Score for Sudden Cardiac Death

Brittany M. Bogle, Hongyan Ning, Jeffrey Goldberger, Sanjay Mehrotra, Donald M. Lloyd-Jones

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death. Methods: The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants. Results: During 10 years’ follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P =.82; black-specific chi-squared 4.1, P =.77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99). Conclusions: The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.

Original languageEnglish (US)
Pages (from-to)532-539.e5
JournalAmerican Journal of Medicine
Volume131
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Sudden Cardiac Death
Calibration
Atherosclerosis
Confidence Intervals
Proportional Hazards Models
Cause of Death
Body Mass Index
Smoking
Cholesterol
Demography
Blood Pressure
Hypertension
Physicians
Lipids

Keywords

  • Coronary heart disease
  • Risk factors
  • Sudden cardiac death

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A Simple Community-Based Risk-Prediction Score for Sudden Cardiac Death. / Bogle, Brittany M.; Ning, Hongyan; Goldberger, Jeffrey; Mehrotra, Sanjay; Lloyd-Jones, Donald M.

In: American Journal of Medicine, Vol. 131, No. 5, 01.05.2018, p. 532-539.e5.

Research output: Contribution to journalArticle

Bogle, Brittany M. ; Ning, Hongyan ; Goldberger, Jeffrey ; Mehrotra, Sanjay ; Lloyd-Jones, Donald M. / A Simple Community-Based Risk-Prediction Score for Sudden Cardiac Death. In: American Journal of Medicine. 2018 ; Vol. 131, No. 5. pp. 532-539.e5.
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AU - Lloyd-Jones, Donald M.

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N2 - Background: Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death. Methods: The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants. Results: During 10 years’ follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P =.82; black-specific chi-squared 4.1, P =.77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99). Conclusions: The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.

AB - Background: Although sudden cardiac death is a leading cause of death in the United States, most victims of sudden cardiac death are not identified as at risk prior to death. We sought to derive and validate a population-based risk score that predicts sudden cardiac death. Methods: The Atherosclerosis Risk in Communities (ARIC) Study recorded clinical measures from men and women aged 45-64 years at baseline; 11,335 white and 3780 black participants were included in this analysis. Participants were followed over 10 years and sudden cardiac death was physician adjudicated. Cox proportional hazards models were used to derive race-specific equations to estimate the 10-year sudden cardiac death risk. Covariates for the risk score were selected from available demographic and clinical variables. Utility was assessed by calculating discrimination (Harrell's C-index) and calibration (Hosmer-Lemeshow chi-squared test). The white-specific equation was validated among 5626 Framingham Heart Study participants. Results: During 10 years’ follow-up among ARIC participants (mean age 54.4 years, 52.4% women), 145 participants experienced sudden cardiac death; the majority occurred in the highest quintile of predicted risk. Model covariates included age, sex, total cholesterol, lipid-lowering and hypertension medication use, blood pressure, smoking status, diabetes, and body mass index. The score yielded very good internal discrimination (white-specific C-index 0.82; 95% confidence interval [CI], 0.78-0.85; black-specific C-index 0.75; 95% CI, 0.68-0.82) and very good external discrimination among Framingham participants (C-index 0.82; 95% CI, 0.79-0.86). Calibration plots indicated excellent calibration in ARIC (white-specific chi-squared 5.3, P =.82; black-specific chi-squared 4.1, P =.77), and a simple recalibration led to excellent fit within Framingham (chi-squared 2.1, P = 0.99). Conclusions: The proposed risk scores may be used to identify those at risk for sudden cardiac death within 10 years and particularly classify those at highest risk who may merit further screening.

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