New approaches for improving cardiovascular risk assessment

Abstract

Introduction and objectives: Clinical guidelines recommend the use of cardiovascular risk assessment tools (risk scores) to predict the risk of events such as cardiovascular death, since these scores can aid clinical decision-making and thereby reduce the social and economic costs of cardiovascular disease (CVD). However, despite their importance, risk scores present important weaknesses that can diminish their reliability in clinical contexts. This study presents a new framework, based on current risk assessment tools, that aims to minimize these limitations.

Methods: Appropriate application and combination of existing knowledge is the main focus of this work. Two different methodologies are applied: (i) a combination scheme that enables data to be extracted and processed from various sources of information, including current risk assessment tools and the contributions of the physician; and (ii) a personalization scheme based on the creation of patient groups with the purpose of identifying the most suitable risk assessment tool to assess the risk of a specific patient.

Results: Validation was performed based on a real patient dataset of 460 patients at Santa Cruz Hospital, Lisbon, Portugal, diagnosed with non-ST-segment elevation acute coronary syndrome. Promising results were obtained with both approaches, which achieved sensitivity, specificity and geometric mean of 78.79%, 73.07% and 75.87%, and 75.69%, 69.79% and 72.71%, respectively.

Conclusions: The proposed approaches present better performances than current CVD risk scores; however, additional datasets are required to back up these findings.

Keywords: Avaliação de risco cardiovascular; Cardiovascular risk assessment; Classificadores de risco; Clinical decision support systems; Combinação de modelos; Model combination; Personalization; Personalização; Risk scores; Sistemas de apoio à decisão clínica.