A competing risk approach for the European Heart SCORE model based on cause-specific and all-cause mortality

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

  • Henrik Støvring
  • Charlotte G Harmsen, Forskningsenheden for Almen Praksis, Syddansk Universitet, Danmark
  • Torbjørn Wisløff, Norwegian Knowledge Centre for the Health Services, Norge
  • Dorte E Jarbøl, Forskningsenheden for Almen Praksis, Syddansk Universitet, Danmark
  • Jørgen Nexøe, Forskningsenheden for Almen Praksis, Danmark
  • Jesper B Nielsen, Institut for Sundhedstjenesteforskning, Syddansk Universitet, Danmark
  • Ivar S Kristiansen, Institute of Health Management and Health Economics, Oslo University, Norge
Background: The European Heart SCORE model constitutes the basis for national guidelines for primary prevention and treatment of cardiovascular disease (CVD) in several European countries. The model estimates individuals' 10-year CVD mortality risks from age, sex, smoking status, systolic blood pressure, and total cholesterol level. The SCORE model, however, is not mathematically consistent and does not estimate all-cause mortality. Our aim is to modify the SCORE model to allow consistent estimation of both CVD-specific and all-cause mortality.Methods: Using a competing risk approach, we first re-estimated the cause-specific risk of dying from cardiovascular disease, and secondly we incorporated non-CVD mortality. Finally, non-CVD mortality was allowed to also depend on smoking status, and not only age and sex. From the models, we estimated CVD-specific and all-cause 10-year mortality risk, and the expected residual lifetime together with corresponding expected effects of statin treatment.Results: The modified model provided CVD-specific 10-year mortality risks similar to those of the European Heart SCORE model. Incorporation of non-CVD mortality increased 10-year mortality risks, in particular for older individuals. When non-CVD mortality was assumed unaffected by smoking status, the absolute risk reduction due to statin treatment ranged from 0.0% to 3.5%, whereas the gain in expected residual lifetime ranged from 3 to 11 months. Statin effectiveness increased for non-smokers and declined for smokers, when smoking was allowed to influence non-CVD mortality.Conclusion: The modified model provides mathematically consistent estimates of mortality risk and expected residual lifetime together with expected benefits from statin treatment.
OriginalsprogEngelsk
TidsskriftEuropean Journal of Preventive Cardiology
Vol/bind20
Nummer5
Sider (fra-til)827-36
Antal sider10
ISSN2047-4873
DOI
StatusUdgivet - okt. 2013

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