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Ann Thorac Surg 2005;80:396-398
© 2005 The Society of Thoracic Surgeons

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The statistician's page

What is the Future of Mortality Prediction Models in Heart Valve Surgery?

Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire

The first 300 words of the full text of this article appear below.

Doctor Jin and associates focus on validation and improvement of logistic regression models for the prediction of early mortality after heart valve surgery in this issue of The Annals of Thoracic Surgery [1]. The intent of this brief editorial is to place their work and risk prediction models in general into the context of the day-to-day demands of cardiac surgery practice for reliable patient counseling and surgeon accountability for adverse outcomes.

The authors reviewed previously published models from several large series. They examined one of them, the Northern New England Cardiovascular Disease Study Group (NNECDSG) prediction models [2] for early mortality after heart valve surgery, to validate their transportability and effectiveness of performance. The original purpose of the NNECDSG models was to identify critical risk factors associated with early mortality and to bring these to the attention of collaborating clinicians for risk assessment and patient informed consent. Both a scorecard method and the equation of the model for estimating early mortality were presented. The combined aortic and mitral NNECDSG series numbered 8,943 cases (5,793 aortic and 3,150 mitral) during the period from 1991 through 2001, which included a time variable to account for variation in experience with time. The Provident Health System (PHS) combined series numbered 4,920 cases (3,324 aortic and 1,596 mitral) during the more recent period from 1997 through March 2004.

The PHS and NNECDSG series were similar in the distribution of risk factors and the effects they had on short-term mortality. The NNECDSG models were adjusted to the most current era (1999 to 2001), and performed well in predicting mortality for both valve sites in the PHS patients. This suggests that the NNECDSG models as published would have been reliable clinical tools for patient counseling and risk adjustment in the PHS series.

The . . . [Full Text of this Article]

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