Researchers from the Cleveland Clinic and the MetroHealth System have received a four-year, $2.2 million grant from the National Institute on Aging to develop a heart disease risk calculator incorporating environment and neighborhood-level factors in the hopes of determining more effective interventions.
Current prediction models severely underestimate cardiovascular risk in socioeconomically disadvantage neighborhoods because they rely on only clinical indicators such as weight, age and smoking history, according to researchers.
However, the grant will enable researchers to investigate how risk assessment tools can take into consideration other factors that might better predict heart disease.
“Poorer Americans are more likely to suffer from heart attacks and stroke, and are expected to live 10 fewer years than wealthier Americans,” said Jarrod Dalton, co-primary investigator of the grant and assistant professor of medicine in the Department of Quantitative Health Sciences at the Cleveland Clinic’s Lerner Research Institute. “Accurate risk assessment is critical for identifying high-risk patients so that prevention strategies or targeted therapies can be used. We aim to understand better the complexity of residential, economic and clinical factors, and how they contribute to cardiovascular disease risk.”
Researchers will create a new combined research registry based on the electronic health records of more than 200,000 patients at Cleveland Clinic and MetroHealth in order to develop the statistical model. In addition, they will supplement the EHR data with neighborhood-level information from the U.S. Census Bureau and other government agencies.
“By incorporating non-clinical factors related to where people live, we can enhance personalized approach and target more effective interventions for specific subpopulations and ultimately reduce health disparities,” added Adam Perzynski, co-principal investigator and assistant professor of medicine and sociology in the Center for Health Care Research and Policy at MetroHealth in Cleveland.
A study authored by Dalton, Perzynski and their colleagues—which is the basis for the grant from the National Institute on Aging—was published October 3 in the Annals of Internal Medicine, with research demonstrating that neighborhood disadvantage is a powerful predictor of cardiovascular outcomes.
The article, based on an analysis of EHR data from almost 110,000 Cleveland Clinic patients, showed that major cardiovascular events in patients from poorer communities occurred at more than twice the rates predicted by existing risk assessment tools.
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