Regional Validation and Updating of Clinical Predictive Models for Patients with Acute Heart Failure.
Wessler, Benjamin.
2016
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Abstract: Background: It is increasingly common to incorporate risk-based analyses into clinical decisions for patients with cardiovascular disease. While many current cardiovascular guidelines, including those for heart failure, recommend integrating validated clinical predictive models (CPMs), these predictive instruments are rarely used. One major limitation is that heart failure is a heterogen... read moreeous phenotype and the generalizability of heart failure CPMs is largely unknown. Hypothesis: We hypothesize that regional CPMs for patients with acute heart failure (AHF) do not generalize well to patients in other world regions and that regional model performance can be improved with simple updating procedures. Methods: We identified CPMs derived in North America that predict mortality for patients with AHF and validated these models in different world regions to assess performance in a contemporary international clinical trial (N = 4133) of patients with AHF treated with guideline directed medical therapy. Results: We performed independent external validations of 3 compatible CPMs predicting in-hospital mortality, 60 day mortality, and 1 year mortality respectively. CPM performance varied substantially across different world regions (North America, South America, Eastern Europe, and Western Europe). The median percent decrease in discrimination across different world regions was - 40% (range -15% to -92%). Regional calibration was highly variable (Harrell's Eavg range <1% to >19%) however simple updating procedures significantly improved local performance (recalibrated Eavg < 3% across all regions and all models). Conclusions: Regional AHF CPM discrimination and calibration vary substantially across different world regions and local performance must be understood and optimized before these tools can be leveraged to improve patient care.
Thesis (M.S.)--Tufts University, 2016.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Kent.
Committee: David Kent, Robin Ruthazer, and James Udelson.
Keyword: Medicine.read less - ID:
- 79408873t
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