Validation of the REduction of Atherothrombosis for Continued Health (REACH) prediction model for recurrent cardiovascul
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RESEARCH NOTE
Validation of the REduction of Atherothrombosis for Continued Health (REACH) prediction model for recurrent cardiovascular disease among United Arab Emirates Nationals Saif Al‑Shamsi1 and Romona D. Govender2*
Abstract Objectives: Prediction models assist health-care providers in making patient care decisions. This study aimed to externally validate the REduction of Atherothrombosis for Continued Health (REACH) prediction model for recurrent cardiovascular disease (CVD) among the Emirati nationals. Results: There are 204 patients with established CVD, attending Tawam Hospital from April 1, 2008. The data retrieved from electronic medical records for these patients were used to externally validate the REACH prediction model. Baseline results showed the following: 77.0% were men, 69.6% were diagnosed with coronary artery disease, and 87.3% have a single vascular bed involvement. The risk prediction model for cardiovascular mortality performed moderately well [C-statistic 0.74 (standard error 0.11)] in identifying those at high risk for cardiovascular death, whereas for recurrent CVD events, it performed poorly in predicting the next CVD event [C-statistic 0.63 (standard error 0.06)], over a 20-month follow-up. The calibration curve showed poor agreement indicating that the REACH model underestimated both recurrent CVD risk and cardiovascular death. With recalibration, the REACH cardiovas‑ cular death prediction model could potentially be used to identify patients who would benefit from aggressive risk reduction. Keywords: Calibration, Discrimination, External validation, Prediction model, Recurrent cardiovascular disease, United arab emirates Introduction Prediction models assist health-care providers in making important daily patient care decisions by population screening, assessing responses to treatment, intensifying management, and motivating patients toward behavior *Correspondence: [email protected] 2 Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates Full list of author information is available at the end of the article
change [1]. In addition, prediction models help riskstratify patients into low, moderate, high, or very highrisk groups for appropriate prevention and management strategies [1, 2]. Those deemed high- or very-high-risk individuals need far more aggressive management and monitoring [2]. Having the diagnosis of cardiovascular disease (CVD) puts patients at an increased risk for a recurrent CVD event [3]. In a previous study, ischemic heart disease was projected to increase by 138% and 158% for women and men, respectively, from 1990 to 2020 in the Middle East [4]. Although alarming, these
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