@entity65 risk assessment in older XXXX : can we improve on Framingham? British @entity1 's Heart and Health prospective cohort study.

@entity1 @entity2002 @entity301 @entity65 @entity1851
OBJECTIVES: To develop a cardiovascular risk assessment tool that is feasible and easy to use in primary care (general practice (GP) model). DESIGN: Prospective cohort study. SETTING: 23 towns in the United Kingdom. @entity1 : 3582 @entity1 aged 60 to 79 years who were free of @entity301 ( @entity301 ) at entry into the British @entity1 's Heart and Health Study. MAIN OUTCOME MEASURES: Predictive performance of a GP model compared with the standard Framingham model for both @entity301 and @entity65 ( @entity65 ). RESULTS: The Framingham tool predicted @entity301 events over 5 years accurately (predicted 5.7%, observed 5.5%) but overpredicted @entity65 events (predicted 10.5%, observed 6.8%). In higher-risk groups, Framingham overpredicted both @entity301 and @entity65 events and was poorly calibrated for this cohort. Including @entity1851 and @entity2002 with standard Framingham risk factors did not improve discrimination of the model. The GP model, which used age, systolic blood pressure, smoking habit and self-rated health (all of which can be easily obtained in one surgery visit) performed as well as the Framingham risk tool: area under the receiver operating curve discrimination statistic was 0.66 (95% confidence interval (CI) 0.62 to 0.70) for @entity301 and 0.67 (95% CI 0.64 to 0.71) for @entity65 compared with 0.65 (95% CI 0.61 to 0.68) and 0.66 (95% CI 0.62 to 0.69) for the corresponding Framingham models. CONCLUSIONS: An alternative risk assessment based on only a simple routine examination and a small number of pertinent questions may be more useful in the primary care setting. This model appears to perform well but needs to be tested in different populations.
