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Polishing the crystal ball: risk prediction methods need update

DALLAS, Oct. 8 Calculating the risk that a heart attack patient will die or have another heart attack is physicians' attempt at peering into a crystal ball, but their view is clouded. Current calculation methods omit important facts that could better predict a person's future health and guide treatment, researchers report in today's rapid access issue of Circulation: Journal of the American Heart Association.

Risk stratification "scores" allow physicians to predict the likelihood of a person having future health problems associated with a condition like heart disease. Here, researchers examined risk stratification after a heart attack.

"In our study, we found that scores used to predict risk in heart attack patients should consider a patient's other health problems (comorbidity) and a measure of the heart's pumping strength (ejection fraction)," says senior author Vronique L. Roger, M.D., M.P.H., of the division of cardiology and the department of health sciences research at the Mayo Clinic Foundation in Rochester, Minn. "We believe that the current scoring systems should be re-evaluated because most scores do not consider either variable."

The most recent scores that physicians have been using to measure risk in heart attack patients were derived from clinical trials. Roger and colleagues believe, however, that scores should be validated in a more general population to verify their accuracy. In addition, the various scoring methods had not been compared to one another to determine their accuracy.

"Our study has given these scoring systems a reality check and determined that more information should be gathered to predict risk more accurately in the community," Roger says.

Researchers reviewed heart attack records of the population of Olmsted County, Minn., and categorized each patient based on the type of heart attack they had ST segment elevation (STEMI) or non-ST segment elevation (NSTEMI), according to their electrocardiog
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Contact: Carole Bullock
carole.bullock@heart.org
214-706-1279
American Heart Association
7-Oct-2002


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