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Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models

Akyea, Ralph K.; Leonardi-Bee, Jo; Asselbergs, Folkert W.; Patel, Riyaz S.; Durrington, Paul; Wierzbicki, Anthony S.; Ibiwoye, Oluwaseun Helen; Kai, Joe; Qureshi, Nadeem; Weng, Stephen F.


Professor of Medical Statistics and Epidemiology

Folkert W. Asselbergs

Riyaz S. Patel

Paul Durrington

Anthony S. Wierzbicki

Oluwaseun Helen Ibiwoye

Stephen F. Weng


Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models to stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis.

Methods and analysis: Bibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. Hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias Assessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity.


Akyea, R. K., Leonardi-Bee, J., Asselbergs, F. W., Patel, R. S., Durrington, P., Wierzbicki, A. S., …Weng, S. F. (2020). Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models. BMJ Open, 10(7),

Journal Article Type Article
Acceptance Date May 31, 2020
Online Publication Date Jul 27, 2020
Publication Date 2020-07
Deposit Date Jun 4, 2020
Publicly Available Date Jul 27, 2020
Journal BMJ Open
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 10
Issue 7
Article Number e034564
Keywords systematic review, meta-analysis, protocol, cardiovascular disease, recurrence, severity, prognostic, multivariable models
Public URL
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