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Cardiovascular Disease Prognostic Models in Latin America and the Caribbean: A Systematic Review

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dc.contributor.author Carrillo-Larco, Rodrigo M.
dc.contributor.author Altez-Fernandez, Carlos
dc.contributor.author Pacheco-Barrios, Niels
dc.contributor.author Bambs, Claudia
dc.contributor.author Irazola, Vilma
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Danaei, Goodarz
dc.contributor.author Perel, Pablo
dc.date.accessioned 2019-07-04T16:59:23Z
dc.date.available 2019-07-04T16:59:23Z
dc.date.issued 2019
dc.identifier.uri https://hdl.handle.net/20.500.12866/6737
dc.description.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. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:2211-8179
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Caribbean en_US
dc.subject cardiovascular disease en_US
dc.subject human en_US
dc.subject Article en_US
dc.subject priority journal en_US
dc.subject South and Central America en_US
dc.subject systematic review en_US
dc.subject qualitative analysis en_US
dc.subject prognostic assessment en_US
dc.title Cardiovascular Disease Prognostic Models in Latin America and the Caribbean: A Systematic Review en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/j.gheart.2019.03.001
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.04

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