Develop and Apply Electrocardiography-Based Risk Score to Identify Community-Based Elderly Individuals at High-Risk of Mortality

Tzu-Pin Lu; Amrita Chattopadhyay; Kuan-Chen Lu; Jing-Yuan Chuang; Shih-Fan Sherri Yeh; I-Shou Chang; Ching-Yu Julius Chen; I-Chien Wu; Chih-Cheng Hsu; Tzu-Yu Chen; Wei-Ting Tseng; Chao Agnes Hsiung; Jyh-Ming Jimmy Juang

doi:10.3389/fcvm.2021.738061

Develop and Apply Electrocardiography-Based Risk Score to Identify Community-Based Elderly Individuals at High-Risk of Mortality

Front Cardiovasc Med. 2021 Oct 8:8:738061. doi: 10.3389/fcvm.2021.738061. eCollection 2021.

Authors

Tzu-Pin Lu^{1

2}, Amrita Chattopadhyay^{1

2}, Kuan-Chen Lu^{1

2}, Jing-Yuan Chuang³, Shih-Fan Sherri Yeh⁴, I-Shou Chang⁵, Ching-Yu Julius Chen⁶, I-Chien Wu⁵, Chih-Cheng Hsu⁵, Tzu-Yu Chen⁵, Wei-Ting Tseng⁵, Chao Agnes Hsiung⁵, Jyh-Ming Jimmy Juang⁶

Affiliations

¹ Department of Public Health, Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
² Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan.
³ Department of Medical Laboratory Science and Biotechnology, China Medical University, Taichung, Taiwan.
⁴ Department of Environmental and Occupational Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
⁵ Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
⁶ Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Abstract

With an aging world population, risk stratification of community-based, elderly population is required for primary prevention. This study proposes a combined score developed using electrocardiographic (ECG) parameters and determines its long-term prognostic value for predicting risk of cardiovascular mortality. A cohort-study, conducted from December 2008 to April 2019, enrolled 5,380 subjects in Taiwan, who were examined, using three-serial-12-lead ECGs, and their health/demographic information were recorded. To understand the predictive effects of ECG parameters on overall-survival, Cox hazard regression analysis were performed. The mean age at enrollment was 69.04 ± 8.14 years, and 47.4% were males. ECG abnormalities, LVH [hazard ratio (HR) = 1.39, 95% confidence intervals (CI) = (1.16-1.67), P = 0.0003], QTc [HR = 1.31, CI = (1.07-1.61), P = 0.007] and PR interval [HR = 1.40, CI = (1.01-1.95), P = 0.04], were significantly associated with primary outcome all-cause death. Furthermore, LVH [HR = 2.37, CI = (1.48-3.79), P = 0.0003] was significantly associated with cardiovascular death, while PR interval [HR = 2.63, CI = (1.24- 5.57), P = 0.01] with unexplained death. ECG abnormality (EA) score was defined based on the number of abnormal ECG parameters for each patient, which was used to divide all patients into sub-groups. Competing risk survival analysis using EA score were performed by using the Gray's test, which reported that high-risk EA groups showed significantly higher cumulative incidence for all three outcomes. Prognostic models using the EA score as predictor were developed and a 10-fold cross validation design was adopted to conduct calibration and discrimination analysis, to establish the efficacy of the proposed models. Overall, ECG model could successfully predict people, susceptible to all three death outcomes (P < 0.05), with high efficacy. Statistically significant (P < 0.001) improvement of the c-indices further demonstrated the robustness of the prediction model with ECG parameters, as opposed to a traditional model with no EA predictor. The EA score is highly associated with increased risk of mortality in elderly population and may be successfully used in clinical practice.

Keywords: Han Chinese population; community-based; electrocardiographic abnormality score; long-term prognosis; prevalence.