ABSTRACT
AIMS: Multivariable prediction models can be used to estimate risk of incident heart failure (HF) in the general population. A systematic review and meta-analysis was performed to determine the performance of models. METHODS AND RESULTS: From inception to 3 November 2022 MEDLINE and EMBASE databases were searched for studies of multivariable models derived, validated and/or augmented for HF prediction in community-based cohorts. Discrimination measures for models with c-statistic data from ≥3 cohorts were pooled by Bayesian meta-analysis, with heterogeneity assessed through a 95% prediction interval (PI). Risk of bias was assessed using PROBAST. We included 36 studies with 59 prediction models. In meta-analysis, the Atherosclerosis Risk in Communities (ARIC) risk score (summary c-statistic 0.802, 95% confidence interval [CI] 0.707-0.883), GRaph-based Attention Model (GRAM; 0.791, 95% CI 0.677-0.885), Pooled Cohort equations to Prevent Heart Failure (PCP-HF) white men model (0.820, 95% CI 0.792-0.843), PCP-HF white women model (0.852, 95% CI 0.804-0.895), and REverse Time AttentIoN model (RETAIN; 0.839, 95% CI 0.748-0.916) had a statistically significant 95% PI and excellent discrimination performance. The ARIC risk score and PCP-HF models had significant summary discrimination among cohorts with a uniform prediction window. 77% of model results were at high risk of bias, certainty of evidence was low, and no model had a clinical impact study. CONCLUSIONS: Prediction models for estimating risk of incident HF in the community demonstrate excellent discrimination performance. Their usefulness remains uncertain due to high risk of bias, low certainty of evidence, and absence of clinical effectiveness research.
Subject(s)
Atherosclerosis , Heart Failure , Male , Humans , Female , Heart Failure/epidemiology , Bayes Theorem , Risk FactorsABSTRACT
Objetivo: identificar variables asociadas a factores deriesgo psicosociales del trabajo en médicos de una EmpresaSocial del Estado (ese) localizada en Cartagena de Indias.Metodología: se realizó un estudio de corte. Población:197 médicos de consulta externa y urgencias trabajadoresde la ese. Para medir los factores psicosociales se utilizó elCuestionario de evaluación de riesgos psicosociales del trabajo(istas21), adaptación al español del Cuestionario psicosocialde Copenhague (CoPsoQ). Para el análisis estadístico seutilizó el programa SPSS versión 17®, aplicando la pruebano paramétrica Mann-Whitney U para estimar asociacionesentre variables. Resultados: participaron 170 médicos. El88.8% presentó una exposición favorable para la salud enlas dimensiones: apoyo social y calidad de liderazgo y doblepresencia. El 69,4% presentó exposición desfavorable en ladimensión inseguridad. Los médicos generales se encuentranen condiciones más desfavorables que los especialistas en lasdimensiones: inseguridad y doble presencia (Prob. Mann-Whitney U < 0,05). Los médicos de consulta externa tienenmás deterioro en las dimensiones: apoyo social y calidad deliderazgo que los del área de urgencias (Prob. Mann-Whitney U< 0,05). Los médicos de estratos más altos presentan una mayordesfavorabilidad que los de estratos más bajos en la dimensión:exigencias psicológicas (Prob. Mann-Whitney U < 0,05).
Objective: to determine the variables associated withpsychosocial risk factors among the doctors of a stateownedsocial welfare enterprise providing health servicesin Cartagena. Methodology: a cross-sectional study on apopulation of 197 doctors from the enterprises outpatientand emergency services. The istas21 questionnaire, a Spanishadaptation of the Copenhagen Psychosocial Questionnaire(copsoq), was used to assess psychosocial factors. Statisticalanalysis was performed using the program SPSS® version 17,and the non-parametric Mann-Whitney U test was appliedto estimate the associations between variables. Results:170 doctors participated in this study; 88.8% of which hadfavorable exposure to risk factors in the following dimensions:social support and quality of leadership and Double presence.69.4% showed adverse exposure in the insecurity dimension.In the dimensions Insecurity and Double Presence, generalpractitioners were in worse conditions than specialists(Mann-Whitney U Prob<0.05). Additionally, doctors fromthe outpatient service showed more deterioration in the socialsupport and quality of leadership dimensions than those fromthe emergency service (Mann-Whitney U Prob<0.05). As forthe psychological demands dimension, doctors from highersocioeconomic strata showed higher unfavorable scores thanthose from lower strata (Mann-Whitney U Prob<0.05).
