CONCEPT VALIDATION AND COMPARATIVE EVALUATION OF BASELINE RISK PREDICTIVE MODELS FOR EFFECTIVE CLINICAL DECISION-MAKING AND OUTCOME ASSESSMENT
Author(s)
Sandhu HK, Miller III CC
McGovern Medical School at UTHealth, Houston, TX, USA
OBJECTIVES: Utilization of predictive risk-score is a well-documented tool for medical decision-making. However, constructing disease-specific risk-model is complex, and often poorly generalizable. We previously showed effectiveness of a simple vascular-disease risk-equivalents (VDRE) score derived from medical-history, was strongly predictive of post aortic-surgery mortality-risk. We sought to validate this scoring paradigm by applying it to a population sample, and to compare its performance with the well-established Framingham Risk-Score (FRS) for cardiovascular mortality-risk. METHODS: We accessed publically available, de-identified limited-dataset of the Framingham Cohort-study from Harvard-edX website. FRS for 10-year mortality and VDRE burden (assigning 1-point each for coronary-disease, cerebrovascular-disease, peripheral vascular disease, aortic surgery/disease, chronic kidney disease and metabolic-diseases (diabetes or hyperlipidemia) were computed. Logistic-regression was performed for C-statistics and pseudo-R-squared comparative-analysis between FRS and VDRE scores. Inter-tool comparison was performed using empirical method of DeLong for comparing ROC curves in NCSS 11. All other computations were performed using SAS 9.4. RESULTS: Upon DeLong ROC curve estimation analysis (Figure), no significant difference between the two methods was identified p=0.21. CONCLUSIONS: VDRE burden is highly specific for predicting long-term mortality risk, generalizes well to a population-based setting, and is comparable to an established, validated risk score (FRS). VDRE is a simple, readily obtainable clinical decision making tool that can be used for pre-surgical triage, planning and patient-centered decision-making.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PCV122
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care
Topic Subcategory
Health Care Research, Health Disparities & Equity, Quality of Care Measurement, Risk-sharing Approaches, Treatment Patterns and Guidelines
Disease
Cardiovascular Disorders, Diabetes/Endocrine/Metabolic Disorders, Multiple Diseases, Urinary/Kidney Disorders