COSEHC global vascular risk management quality improvement program: rationale and design

Abstract

Background: The Consortium for Southeastern Hypertension Control (COSEHC) promotes global risk factor management in patients with metabolic syndrome. The COSEHC Global Vascular Risk Management Study (GVRM) intends to quantify these efforts on long-term patient outcomes. The objectives of this study were to present baseline demographics of patients enrolled in the GVRM, calculate a modified COSEHC risk score using 11 variables (COSEHC-11), and compare it with the original COSEHC-17 and Framingham, Prospective Cardiovascular Münster (PROCAM), and Systemic Coronary Risk Evaluation (SCORE) risk scores.

Methods: Deidentified electronic medical records of enrolled patients were used to calculate the risk scores. The ability of the COSEHC-11 score to predict the COSEHC-17 score was assessed by regression analysis. Raw risk scores were converted to probability estimates of fatal coronary heart disease (CHD) and compared with predicted risks from other algorithms.

Results: Of the 177,404 patients enrolled, 43,676 had data for all 11 variables. The COSEHC-11 score (mean ± standard deviation) of these 43,676 patients was 31.75 ± 11.66, implying a five-year fatal CHD risk of 1.4%. The COSEHC-11 score was highly predictive of the COSEHC-17 score (R(2) = 0.93; P < 0.0001) and correlated well with the SCORE algorithm.

Conclusion: The COSEHC-11 risk score is statistically similar to the COSEHC-17 risk score and should be a viable tool for evaluating its ability to predict five-year cardiovascular mortality in the coming years.

Keywords: cardiovascular risk; electronic medical records; metabolic syndrome.

Figure 1

COSEHC-17 versus COSEHC-11 risk score scatter plot with regression line and 95% confidence limits. The solid blue line shows the ordinary least-squares regression line (intercept = 3.19; slope = 1.05; R² = 0.93; P < 0.0001). The thin green lines represent the 95% confidence bounds. The outliers above the 95% confidence limits included primarily patients with a history of stroke or myocardial infarction. These two variables, while heavily weighted in the COSEHC-17 score, were typically unreported in the electronic medical record system and were relatively uncommon even in the complete dataset. Abbreviation: COSEHC, Consortium for Southeastern Hypertension Control.