Validation of the ARIC prediction model for sudden cardiac death in the European population: The ESCAPE-NET project

• Published in: The American heart journal 2023-08, Vol.262 (15), p.55-65
• Main Authors: Welten, Sabrina J.G.C., Remmelzwaal, Sharon, Blom, Marieke T., van der Heijden, Amber A., Nijpels, Giel, Tan, Hanno L., van Valkengoed, Irene, Empana, Jean-Philippe, Jouven, Xavier, Ågesen, Frederik Nybye, Warming, Peder Emil, Tfelt-Hansen, Jacob, Prescott, Eva, Jabbari, Reza, Elders, Petra J.M.
• Format: Article
• Language: English
• Subjects: Adult; Arteriosclerosis; Atherosclerosis; Autopsies; Blood pressure; Calibration; Cardiovascular disease; Cholesterol; Cohort analysis; Death; Death, Sudden, Cardiac - epidemiology; Death, Sudden, Cardiac - etiology; Diabetes; Europe - epidemiology; Fatalities; Female; Glucose; Goodness of fit; Heart; Humans; Inspection; Life Sciences; Male; Medical prognosis; Medical records; Middle Aged; Mortality; Prediction models; Predictions; Questionnaires; Risk; Risk Assessment - methods; Risk Factors; Self report; Statistical tests; Visual discrimination
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2023.03.018

Sudden cardiac death is responsible for 10% to 20% of all deaths in Europe. The current study investigates how well the risk of sudden cardiac death can be predicted. To this end, we validated a previously developed prediction model for sudden cardiac death from the Atherosclerosis Risk in Communities study (USA). Data from participants of the Copenhagen City Heart Study (CCHS) (n=9988) was used to externally validate the previously developed prediction model for sudden cardiac death. The model's performance was assessed through discrimination (C-statistic) and calibration by the Hosmer-Lemeshow goodness-of-fit (HL) statistics suited for censored data and visual inspection of calibration plots. Additional validation was performed using data from the Hoorn Study (N=2045), employing the same methods. During ten years of follow-up of CCHS participants (mean age: 58.7 years, 56.2% women), 425 experienced SCD (4.2%). The prediction model showed good discrimination for sudden cardiac death risk (C-statistic: 0.81, 95% CI: 0.79-0.83). Calibration was robust (HL statistic: P=0.8). Visual inspection of the calibration plot showed that the calibration could be improved. Sensitivity was 89.8%, and specificity was 60.6%. The positive and negative predictive values were 10.1% and 99.2%. Model performance was similar in the Hoorn Study (C-statistic: 0.81, 95% CI: 0.77-0.85 and the HL statistic: 1.00). Our study showed that the previously developed prediction model in North American adults performs equally well in identifying those at risk for sudden cardiac death in a general North-West European population. However, the positive predictive value is low.