Abstract 17261: Comparing SF-36 Scores versus Traditional and Novel Biomarkers to Predict Mortality in Primary Cardiac Prevention Patients
Background: Risk stratification plays an important role in evaluating patients with no known cardiovascular disease (CVD). Few studies have investigated health-related quality of life questionnaires such as the Medical Outcomes Study Short Form-36 (SF-36®) as predictive tools for mortality, particularly in direct comparison with biomarkers. Our objective is to measure the relative effectiveness of SF-36® scores in predicting mortality when compared to traditional and novel biomarkers in a primary prevention population.
Methods: The study analyzed patient characteristics and all-cause mortality among 7056 consecutive patients evaluated for primary cardiac prevention in a cardiology clinic at Cleveland Clinic between January 1996 and April 2011. Patient characteristics included history and physical examination, SF-36® questionnaire and a laboratory panel consisting of total cholesterol, triglycerides, HDL, LDL, apolipoprotein A, apolipoprotein B, fasting glucose, hemoglobin A1c, creatinine, homocysteine, lipoprotein(a), fibrinogen, high-sensitivity C-reactive protein, uric acid and urine albumin:creatinine ratio. The primary outcome was all-cause mortality.
Results: A low SF-36® physical score independently predicted a 6-fold increase in death at 8 years (above vs. below median Hazard Ratio [95% confidence interval] 5.99 [3.86-9.35], p<0.001). In a univariate analysis, SF-36® physical score had a c-index of 0.75, which was superior to that of all the biomarkers. It also carried incremental predictive ability when added to non-laboratory risk factors (Net Reclassification Index = 45.4%), as well as Framingham risk score components (Net Reclassification Index = 59.4%). Biomarkers added no incremental predictive value to a non-laboratory risk factor model when combined to SF-36 physical score.
Conclusions: The SF-36® physical score is a reliable predictor of mortality in patients without CVD, and outperformed most studied traditional and novel biomarkers. In an era of rising healthcare costs, the SF-36® questionnaire could be used as a simple and cost-effective predictor of mortality.
Author Disclosures: R. Lahoud: None. V. Chongthammakun: None. D. Brennan: None. L. Cho: None.
- © 2015 by American Heart Association, Inc.