Title
Cardiovascular Disease Prognostic Models in Latin America and the Caribbean: A Systematic Review
Date Issued
01 March 2019
Access level
open access
Resource Type
journal article
Author(s)
Pacheco-Barrios N.
Bambs C.
Irazola V.
Danaei G.
Perel P.
Publisher(s)
Elsevier B.V.
Abstract
Background: Cardiovascular prognostic models guide treatment allocation and support clinical decisions. Whether there are valid models for Latin American and Caribbean (LAC) populations is unknown. Objective: This study sought to identify and critically appraise cardiovascular prognostic models developed, tested, or recalibrated in LAC populations. Methods: The systematic review followed the CHARMS (CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies) framework (PROSPERO [International Prospective Register of Systemic Reviews]: CRD42018096553). Reports were included if they followed a prospective design and presented a multivariable prognostic model; reports were excluded if they studied symptomatic individuals or patients. The following search engines were used: EMBASE, MEDLINE, Scopus, SciELO, and LILACS. Risk of bias assessment was conducted with PROBAST (Prediction model Risk Of Bias ASsessment Tool). No quantitative summary was conducted due to large heterogeneity. Results: From 2,506 search results, 8 studies (N = 130,482 participants) were included for qualitative synthesis. We could not identify any cardiovascular prognostic model developed for LAC populations; reviewed reports evaluated available models or conducted a recalibration analysis. Only 1 study included a Caribbean population (Puerto Rico); 3 studies were retrieved from Chile; 2 from Argentina, Brazil, Colombia, and Uruguay; and 1 from Mexico. Four studies included population-based samples, and the other 4 included people affiliated to a health facility (e.g., prevention clinics). Most studied participants were older than 50 years, and there were more women in 5 reports. The Framingham model was assessed 6 times, and the American College of Cardiology/American Heart Association pooled equation was assessed twice. Across the prognostic models assessed, calibration varied widely from one population to another, showing great overestimation particularly in some subgroups (e.g., highest risk). Discrimination (e.g., C-statistic) was acceptable for most models; for Framingham it ranged from 0.66 to 0.76. The American College of Cardiology/American Heart Association pooled equation showed the best discrimination (0.78). That there were few outcome events was the most important methodological limitation of the identified studies. Conclusions: No cardiovascular prognostic models have been developed in LAC, hampering key evidence to inform public health and clinical practice. Validation studies need to improve methodological issues.
Start page
81
End page
93
Volume
14
Issue
1
Language
English
OCDE Knowledge area
Sistema cardiaco, Sistema cardiovascular
Scopus EID
2-s2.0-85064637605
PubMed ID
Source
Global Heart
ISSN of the container
22118160
Sponsor(s)
This study was funded by Strategic Award, Wellcome Trust-Imperial College Centre for Global Health Research (100693/Z/12/Z) and Imperial College London Wellcome Trust Institutional Strategic Support Fund (Global Health Clinical Research Training Fellowship; 294834/Z/16/Z ISSF ICL). The authors thank Jahanna A.A.G. Damen for providing additional material of a previous global systematic review useful for this work.
Sources of information:
Directorio de Producción Científica
Scopus