External Validation of SCORE2-OP for Predicting Cardiovascular Mortality in Frail Geriatric Outpatients

Abstract

Objectives In preventing atherosclerotic cardiovascular diseases (ASCVDs) in frail older people, it is essential to balance estimated cardiovascular disease (CVD) risk with potential treatment benefits and harms. Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP) estimates CVD risk in older people but has not been validated in frail geriatric patients. We evaluated the performance of SCORE2-OP for predicting CVD mortality in this group. Design External validation study. Setting and Participants Amsterdam Ageing Cohort, including 1797 geriatric outpatients. Methods Data on incident myocardial infarction and stroke were unavailable. Five-year all-cause and CVD mortality were calculated by Kaplan-Meier estimates. For calibration, we compared 5-year CVD mortality with 5-year CVD risk calculated by SCORE2-OP in observed-to-expected ratios. Discrimination was assessed with Harrell's C-index. Analyses were stratified by ASCVD history, and physical and cognitive functioning. Results We included 1797 patients (median age, 79 years; interquartile range, 75–84; 48% male; 39% ASCVD history). Over a median survival time of 2.0 years (interquartile range, 1.0–3.3), 623 people (35%) died, including 95 from CVD. The 5-year CVD mortality was 6.4% (95% CI, 5.1–7.7), the mean calculated CVD risk was 7.9%. The overall observed-to-expected ratio for cardiovascular mortality was 0.81 (95% CI, 0.80–0.82), and 0.52 (95% CI, 0.51–0.53) in people without ASCVD history. C-indices were 0.59 (95% CI, 0.47–0.70) overall and 0.67 (95% CI, 0.50–0.85) in those without ASCVD history. Stratification by physical and cognitive functioning did not impact C-indices. Conclusions and Implications In a frail geriatric outpatient population, SCORE2-OP showed notable discrimination for CVD mortality in those without ASCVD history. This suggests that SCORE2-OP can be used for CVD risk estimation in these frail outpatients.