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

Pubmed ID: 29273191

Pubmed Central ID: PMC5910195

Journal: The American journal of medicine

Publication Date: May 1, 2018

MeSH Terms: Humans, Male, Female, United States, Cohort Studies, Age Factors, Middle Aged, Smoking, Longitudinal Studies, Body Mass Index, Risk Assessment, Proportional Hazards Models, Sex Factors, Blood Pressure, Diabetes Mellitus, Cholesterol, Antihypertensive Agents, Hypolipidemic Agents, Death, Sudden, Cardiac, White People, Black or African American

Grants: R21 HL085375, T32 HL007055

Authors: Lloyd-Jones DM, Ning H, Bogle BM, Mehrotra S, Goldberger JJ

Cite As: Bogle BM, Ning H, Goldberger JJ, Mehrotra S, Lloyd-Jones DM. A Simple Community-Based Risk-Prediction Score for Sudden Cardiac Death. Am J Med 2018 May;131(5):532-539.e5. Epub 2017 Dec 19.

Studies:

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.