Evidence map›Paper›PMID 15157279›Full record

ArticleBMC medical informatics and decision making2004

Description and validation of a Markov model of survival for individuals free of cardiovascular disease that uses Framingham risk factors.

Chris Martin, Mark Vanderpump, Joyce French

Abstract readValidation Study
In one paragraph

Article in BMC medical informatics and decision making, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

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2citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Making decisions about mammography.BMJ (Clinical research ed.) · 2005
    Article
4 · The record

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5 · Who and what money

Authors and funding

3 authors.

Chris MartinLaindon Health Centre Primary Care Research Team, Essex, SS15 5TR, United Kingdom. chris.martin@laindonhc.org.uk
Mark Vanderpump
Joyce French

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEstimation of cardiovascular disease risk is increasingly used to inform decisions on interventions, such as the use of antihypertensives and statins, or to communicate the risks of smoking. Crude 10-year cardiovascular disease risk risks may not give a realistic view of the likely impact of an intervention over a lifetime and will underestimate of the risks of smoking. A validated model of survival to act as a decision aid in the consultation may help to address these problems. This study aims to describe the development of such a model for use with people free of cardiovascular disease and evaluates its accuracy against data from a United Kingdom cohort.

methodsA Markov cycle tree evaluated using cohort simulation was developed utilizing Framingham estimates of cardiovascular risk, 1998 United Kingdom mortality data, the relative risk for smoking related non-cardiovascular disease risk and changes in systolic blood pressure and serum total cholesterol total cholesterol with age. The model's estimates of survival at 20 years for 1391 members of the Whickham survey cohort between the ages of 35 and 65 were compared with the observed survival at 20-year follow-up.

resultsThe model estimate for survival was 75% and the observed survival was 75.4%. The correlation between estimated and observed survival was 0.933 over 39 subgroups of the cohort stratified by estimated survival, 0.992 for the seven 5-year age bands from 35 to 64, 0.936 for the ten 10 mmHg systolic blood pressure bands between 100 mmHg and 200 mmHg, and 0.693 for the fifteen 0.5 mmol/l total cholesterol bands between 3.0 and 10.0 mmol/l. The model significantly underestimated mortality in those people with a systolic blood pressure greater than or equal to 180 mmHg (p = 0.006). The average gain in life expectancy from the elimination of cardiovascular disease risk as a cause of death was 4.0 years for all the 35 year-old men in the sample (n = 24), and 1.8 years for all the 35 year-old women in the sample (n = 32).

conclusionsThis model accurately estimates 20-year survival in subjects from the Whickham cohort with a systolic blood pressure below 180 mmHg.

Indexed as

AdultAgedCardiovascular DiseasesCohort StudiesComputer SimulationDecision Making, Computer-AssistedFemaleHumansMaleMarkov ChainsMiddle AgedPredictive Value of TestsSurvivalUnited Kingdom

Identifiers

PMID15157279
PMCPMC434521

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