ArticleDiagnostic and prognostic research2018
Predictors for independent external validation of cardiovascular risk clinical prediction rules: Cox proportional hazards regression analyses.
Article in Diagnostic and prognostic research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.
- Research inefficiencies in external validation studies of the Framingham Wilson coronary heart disease risk rule: A systematic review.PloS one · 2024Pooled it
- Construction and validation of an oral frailty risk prediction model for community-dwelling older adults.BMC geriatrics · 2025Article
- External Validations of Cardiovascular Clinical Prediction Models: A Large-Scale Review of the Literature.Circulation. Cardiovascular quality and outcomes · 2021Review
- GPs' familiarity with and use of cardiovascular clinical prediction rules: a UK survey study.BJGP open · 2020Article
- Article
- Predicting donor, recipient and graft survival in living donor kidney transplantation to inform pretransplant counselling: the donor and recipient linked iPREDICTLIVING tool - a retrospective study.Transplant international : official journal of the European Society for Organ Transplantation · 2020Article
- Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis.Scientific reports · 2020Article
- Methodological standards for the development and evaluation of clinical prediction rules: a review of the literature.Diagnostic and prognostic research · 2019Review
Corrections and comments
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Authors and funding
3 authors at 1 institution in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundClinical prediction rules (CPRs) should be externally validated by independent researchers. Although there are many cardiovascular CPRs, most have not been externally validated. It is not known why some CPRs are externally validated by independent researchers and others are not.
methodsWe analyzed cardiovascular risk CPRs included in a systematic review. Independent external validations were identified by forward citation searches of derivation studies. Time between the publication of a cardiovascular CPR and the first independent external validation was calculated. We assessed Kaplan-Meier estimates of the probability to have an independent external validation. Using univariable Cox regression, we explored whether characteristics of derivation (design, location, sample size, number of predictors, presentation format, validation in derivation), reporting (participants, predictors, outcomes, performance measure, information for risk calculation), and publication (journal impact factor) are associated with time to the first independent external validation.
resultsOf 125 cardiovascular risk CPRs, 29 had an independent external validation. The median follow-up was 118 months (95% CI, 99-130). The 25th percentile of event time was 122 months (95% CI, 91-299). Cardiovascular risk CPRs from the USA were 4.15 times (95% CI, 1.89-9.13) more likely to have an independent external validation. Increasing the sample size of derivation by ten times was associated with a 2.32-fold (95% CI, 1.37-3.91) increase in the probability of having an independent external validation. CPRs presented with an internal validation tend to get an independent external validation sooner (HR = 1.73, 95% CI, 0.77-3.93). CPRs reporting all the information necessary for calculating individual risk were 2.65 (95% CI, 1.01-6.96) times more likely to have an independent external validation. Publishing a cardiovascular risk CPR in a journal that has one unit higher impact factor was associated with a 6% (95% CI, 3-9) higher likelihood of an independent external validation.
conclusionsThe probability for cardiovascular risk CPRs to get an independent external validation was low even many years after their derivations. Authors of new cardiovascular risk CPRs should consider using adequate sample size, conducting an internal validation, and reporting all the information needed for risk calculation as these features were associated with an independent external validation.
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Registered trials
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