External Validation of SCORE2-OP for Predicting Cardiovascular Mortality in Frail Geriatric Outpatients

OBJECTIVES: In preventing atherosclerotic cardiovascular diseases (ASCVDs) in frail older people, it is essential to balance estimated cardiovascular disease (CVD) risk with potential treatment benefits and harms. Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP) estimates CVD risk in older people but has not been validated in frail geriatric patients. We evaluated the performance of SCORE2-OP for predicting CVD mortality in this group. DESIGN: External validation study. SETTING AND PARTICIPANTS: Amsterdam Ageing Cohort, including 1797 geriatric outpatients. METHODS: Data on incident myocardial infarction and stroke were unavailable. Five-year all-cause and CVD mortality were calculated by Kaplan-Meier estimates. For calibration, we compared 5-year CVD mortality with 5-year CVD risk calculated by SCORE2-OP in observed-to-expected ratios. Discrimination was assessed with Harrell's C-index. Analyses were stratified by ASCVD history, and physical and cognitive functioning. RESULTS: We included 1797 patients (median age, 79 years; interquartile range, 75-84; 48% male; 39% ASCVD history). Over a median survival time of 2.0 years (interquartile range, 1.0-3.3), 623 people (35%) died, including 95 from CVD. The 5-year CVD mortality was 6.4% (95% CI, 5.1-7.7), the mean calculated CVD risk was 7.9%. The overall observed-to-expected ratio for cardiovascular mortality was 0.81 (95% CI, 0.80-0.82), and 0.52 (95% CI, 0.51-0.53) in people without ASCVD history. C-indices were 0.59 (95% CI, 0.47-0.70) overall and 0.67 (95% CI, 0.50-0.85) in those without ASCVD history. Stratification by physical and cognitive functioning did not impact C-indices. CONCLUSIONS AND IMPLICATIONS: In a frail geriatric outpatient population, SCORE2-OP showed notable discrimination for CVD mortality in those without ASCVD history. This suggests that SCORE2-OP can be used for CVD risk estimation in these frail outpatients.