Division of Primary Care, University of Nottingham, Nottingham, UK
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
BMJ Open. 2020 Jul 27;10(7):e034564. doi: 10.1136/bmjopen-2019-034564.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models for stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis.
Bibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. A hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias ASsessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity.
Ethics approval is not required. The results of this study will be submitted to relevant conferences for presentation and a peer-reviewed journal for publication.
CRD42019149111.
心血管疾病（CVD）是全球发病率和死亡率的主要原因。随着 CVD 的早期诊断和治疗的进步以及预期寿命的延长，越来越多的人在初次 CVD 事件后幸存下来。然而，用于对患有已确诊 CVD 的患者进行疾病严重程度风险分层的模型对于有效的二级预防策略来说并不充分。用于分层 CVD 风险的多变量预后模型可能允许进行个性化的治疗干预。本综述旨在系统地回顾现有的多变量预后模型，以评估成人 CVD 患者复发 CVD 或主要不良心血管事件的风险。
将从数据库建立之初到 2020 年 4 月，使用与临床领域和预后相关的术语，在 Ovid MEDLINE、EMBASE、PsycINFO 和 Web of Science 等文献数据库中进行检索。还将对手头现有的研究的参考文献进行手工搜索，以确定其他已发表的研究。将不限制出版物的语言。合格的研究提供了多变量模型（推导或验证），这些模型适用于年龄在 16 岁及以上、已确诊 CVD 的成年人，并且至少报告了主要不良心血管事件（定义为冠心病、中风、外周动脉疾病、心力衰竭或与 CVD 相关的死亡率）的主要结局之一的组成部分。将由两名独立的审查员使用预先确定的标准进行审查。将提取纳入的全文文章的数据。使用预测模型研究风险偏倚评估工具（PROBAST）评估偏倚风险。将使用叙述性方法总结预后模型。如果一个模型在多个验证研究中进行了测试，则将使用随机效应荟萃分析模型总结其预测性能，以说明研究之间的任何异质性。
不需要伦理批准。本研究的结果将提交给相关会议进行展示，并在同行评议的期刊上发表。
PROSPERO 注册号：CRD42019149111。
