Key result
The INDANA risk calculator was more accurate than the Framingham Risk Score in predicting 5-year all-cause (Δc 0.038 in UK) and cardiovascular mortality in hypertensive patients (P<0.0001).
Why the study?
Does the INDANA calculator improve prediction of 5-year mortality compared to the Framingham Risk Score in hypertensive patients?
Cohort (n=62,919)
Yes
Does the INDANA calculator improve prediction of 5-year mortality compared to the Framingham Risk Score in hypertensive patients?
The INDANA risk calculator, which incorporates renal function, provides more accurate 5-year mortality risk prediction and reclassification than the Framingham Risk Score in primary care hypertensive patients.
OBJECTIVE: The aim of this study was to assess the accuracy of a risk calculator that includes renal function as compared with that of the traditional Framingham Risk Score (FRS) in predicting the risk of mortality of hypertensive individuals managed in primary care. METHODS: From the databases of British and Italian General Practitioners, we retrieved demographic and clinical data for 35 101 UK and 27 818 Italian individuals aged 35-74 years with a diagnosis of hypertension. Then, the 5-year incidence of cardiovascular events as well as all-cause and cardiovascular mortality were recorded for both samples. A comparison analysis of the performance of the Individual Data Analysis of Antihypertensive Intervention Trials (INDANA) calculator with that of FRS in predicting 5-year all-cause and cardiovascular mortality risk was made. RESULTS: The INDANA calculator was more accurate than the FRS in predicting all-cause [Δc 0.038, 95% confidence interval (CI) 0.026-0.051 for United Kingdom, and 0.018, 95% CI 0.010-0.027 for Italy, both P < 0.0001] and cardiovascular mortality (Δc 0.050, 95% CI 0.027-0.074 for United Kingdom, and 0.080, 95% CI 0.059-0.101 for Italy, both P < 0.0001). By using the INDANA calculator, 20% of the UK and 10% of the Italian patients were reclassified to higher risk classes for all-cause mortality, and 25 and 28%, respectively were reclassified when cardiovascular mortality was assessed (P < 0.0001 for all). CONCLUSION: The INDANA calculator proved to be more accurate than the FRS in predicting the risk of mortality in hypertensive patients and should be considered for systematic adoption for risk stratification of hypertensive individuals managed in primary care.
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Ravera et al. (2014) conducted a cohort in hypertension (n=62,919). INDANA calculator vs. Framingham Risk Score (FRS) was evaluated on 5-year all-cause and cardiovascular mortality prediction accuracy (change in c-statistic) (Δc 0.038 (UK) and 0.018 (Italy) for all-cause mortality, 95% CI 0.026-0.051 (UK) and 0.010-0.027 (Italy), p=<0.0001). The INDANA risk calculator was more accurate than the Framingham Risk Score in predicting 5-year all-cause (Δc 0.038 in UK) and cardiovascular mortality in hypertensive patients (P<0.0001).
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