ArticleThe lancet. Healthy longevity2021
Effect of competing mortality risks on predictive performance of the QRISK3 cardiovascular risk prediction tool in older people and those with comorbidity: external validation population cohort study.
Article in The lancet. Healthy longevity, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 36 papers, 1 of them a synthesis that pooled it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Characteristics of Cardiovascular Disease Prediction Models Considering Mental Disorders: A Systematic Review.Journal of the American Heart Association · 2026Pooled it
- Cardiovascular risk equations in type 1 diabetes: from generic models to personalized prediction.Annals of medicine · 2026Review
- A multicentre evaluation of cardiovascular risk prediction tools in people living with HIV across England (ECARTH study).HIV medicine · 2026Observational
- Large-scale plasma proteomics improves prediction of heart failure among MASLD individuals: A prospective cohort study.American journal of preventive cardiology · 2026Article
- Cardiovascular Disease Risk Prediction in Patients With Metabolic Dysfunction-Associated Steatohepatitis.Diabetes, obesity & metabolism · 2026Article
- The kidney failure risk equation in people with CKD and multimorbidity: the effect of competing mortality risks.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2026Observational
- Risk estimation of cardiovascular disease in Qatar's primary care settings: application of QRISK3 algorithm and sociodemographic predictors.BMC cardiovascular disorders · 2026Article
- Risk prediction for individual patients and the pitfalls of selecting an optimal prediction model: do not judge a model by its c-statistic.European journal of epidemiology · 2026Article
- Comparative prognostic value of high-sensitivity cardiac troponin T and NT-proBNP for 30-day mortality in non-cardiac critically ill patients.Scientific reports · 2026Article
- From bedside to bench: towards clinical predictive AI research that achieves real-world impact.BMJ digital health & AI · 2026Review
- Predicting hypotension, syncope, and fracture risk in patients indicated for antihypertensive treatment: the STRATIFY models.Nature communications · 2025Article
- Cardiovascular Risk Prediction in Older Adults.Current atherosclerosis reports · 2025Review
- Development and validation of a postpartum cardiovascular disease risk prediction model in women incorporating reproductive and pregnancy-related predictors.BMC medicine · 2025Article
- Meta-prediction of coronary artery disease risk.Nature medicine · 2025Article
- Prevalence and Clinical Correlates of Radiologically Detected Coronary Artery Disease in Chronic Obstructive Pulmonary Disease: A Cross-Sectional Observational Study.American journal of respiratory and critical care medicine · 2025Observational
- Scoping review of the use of multimorbidity variables in cardiovascular disease risk prediction.BMC public health · 2025Article
- Cardiovascular Risk and Plasma N-terminal Pro-B-type Natriuretic Peptide in Adults With Resistance to Thyroid Hormone β.Journal of the Endocrine Society · 2025Article
- Key Determinants of Cardiovascular Outcomes in Multi-Ethnic Patients With Rheumatic Disease Using JAK Inhibitors.Musculoskeletal care · 2025Article
- Predicting cardiovascular disease risk using retinal optical coherence tomography imaging.Frontiers in artificial intelligence · 2025Article
- Comparative effectiveness and prescribing trends of modified release versus immediate release indapamide in patients with hypertension: cohort study.BMJ medicine · 2025Article
Corrections and comments
- Commented on by
- Erratum issuedCorrection to2021
Authors and funding
7 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundPrimary prevention of cardiovascular disease (CVD) is guided by risk-prediction tools, but these rarely account for the risk of dying from other conditions (ie, competing mortality risk). In England and Wales, the recommended risk-prediction tool is QRISK2, and a new version (QRISK3) has been derived and internally validated. We aimed to externally validate QRISK3 and to assess the effects of competing mortality risk on its predictive performance.
methodsFor this retrospective population cohort study, we used data from the Clinical Practice Research Datalink. We included patients aged 25-84 years with no previous history of CVD or statin treatment who were permanently registered with a primary care practice, had up-to-standard data for at least 1 year, and had linkage to Hospital Episode Statistics discharge and Office of National Statistics mortality data. We compared the QRISK3-predicted 10-year CVD risk with the observed 10-year risk in the whole population and in important subgroups of age and multimorbidity. QRISK3 discrimination and calibration were examined with and without accounting for competing risks.
findingsOur study population included 1 484 597 women with 42 451 incident CVD events (4·9 cases per 1000 person-years of follow-up, 95% CI 4·89-4·99), and 1 420 176 men with 53 066 incident CVD events (6·7 cases per 1000 person-years, 6·66-6·78), with median follow-up of 5·0 years (IQR 1·9-9·2). Non-CVD death rose markedly with age (0·4% of women and 0·5% of men aged 25-44 years had a non-CVD death
interpretationQRISK3 performed well at the whole population level when ignoring competing mortality risk. The tool performed considerably less well in important subgroups, including older people and people with multimorbidity, and less well again after accounting for competing mortality risk.
fundingNational Institute for Health Research.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.