Performance of Cardiovascular Disease (CVD) Risk Assessment Tools in Clinical Practice - Agreement Between Different CVD Risk Scores Among Patients Attending NCD Clinic in a Tertiary Care Setting: A Prospective Observational Study

Background: We aimed to compare performance of three cardiovascular disease (CVD) risk estimation tools; the World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction tool, the American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease (ACC/AHA ASCVD) Risk Estimator, and Framingham risk score (FRS) in estimating the risk of fatal and nonfatal cardiovascular events. Methods: We conducted a prospective, observational, hospital-based study involving 200 high-risk study participants, who visited a non-communicable disease clinic in a tertiary care hospital in eastern India. The 10-year CVD risk was estimated using the ACC/AHA ASCVD Risk Estimator, FRS, and the WHO/ISH risk prediction tool. We used kappa statistics to determine agreement among these CVD risk estimators. Results: The mean (SD) age of study participants was 54.07 (9.15) years, and the majority (63.5%) were males. About 96% of the participants were diabetic, 33.5% were hypertensive, and 16% were current smokers. About 18%, 20.5%, and 0.5% were classified as high-risk using the ACC/AHA ASCVD Risk Estimator, FRS, and WHO/ISH risk tools, respectively. The agreement was moderate between the ASCVD risk estimator and FRS (Kappa 0.541, P < 0.001) and fair between the ASCVD risk Estimator and WHO/ISH (Kappa 0.305, P < 0.001) and between FRS and WHO/ISH (Kappa 0.314, P < 0.001). Conclusions: A higher level of agreement was found between FRS and ASCVD risk scores compared to the WHO-ISH risk score. The WHO-ISH risk score identified most study participants in the lower-risk category, contrary to the FRS and ASCVD risk scores.