A Retrospective Study On The Tailoring Of Score Charts In A Specialized Tertiary Hypertension Unit

Objective: The use of Systematic Coronary Risk Evaluation (SCORE) charts for low risk countries is recommended for estimating the individual 10-year risks of fatal cardiovascular events in France. These charts were estimated from 12 European cohort studies in 2003. The objective was to compare SCORE predictions to a 10-year risk of fatal cardiovascular disease obtained from Kaplan-Meier in a population of French patients attending in a specialized Tertiary Hypertension Unit (THU) or Paris area during the 2000–2014 period.Design and method: We retrospectively included all consecutive patients attending for a first outpatient visit of the THU between 07/2000 and 12/2014 in this monocentric cohort study. We excluded foreign-born patients. Vital status and causes of deaths were retrieved respectively from the national person identification database and national causes of death database. Risk of fatal cardiovascular disease at 10 years was calculated for each patient using the SCORE model. A Kaplan-Meier model was then fitted to estimate risk of fatal cardiovascular disease at 10 years for each SCORE prediction groups (<1, 1–5, 5–10, >10%) for patients in primary prevention. Results: A total of 8114 patients in primary prevention were included. Their characteristics at the first outpatient visit: median age: 50 years; women: 48%; current smoker: 16.8%; median office SBP: 141 mmHg; median cholesterol levels: 5.25 mmol/l. SCORE risk of fatal cardiovascular disease of 1–5 and 5–10% at 10 years overestimated the actual risk obtained from Kaplan-Meier estimators for both men and women (Table 1). Conclusions: SCORE charts overestimate the risk of fatal cardiovascular disease at 10 years for French hypertensive patients attending a THU and thus are not adapted for day-to-day practice. There is a need to fit a specific model for this population and for other subgroups.