Evaluation of electronic health record analysis as a Prognostic Tool in essential hypertension

Erik Karlsson; A. Johansson; K. Lindqvist

doi:10.5281/zenodo.22813663

Authors

Erik Karlsson Division of Primary Care Research, Fraser Academy of General and Internal Medicine Author https://orcid.org/6929-6701-4704-9977
A. Johansson Department of General and Internal Medicine, Indus Institute for Advanced General and Internal Medicine Author https://orcid.org/0461-2783-8904-1135
K. Lindqvist Department of General and Internal Medicine, Krishna Center for General and Internal Medicine Author https://orcid.org/3661-7324-4655-8773

DOI:

https://doi.org/10.5281/zenodo.22813663

Keywords:

essential hypertension, electronic health records, prognostic model, cardiovascular risk, risk prediction

Abstract

Graphical abstract

Background: Guideline-endorsed risk scores such as the Framingham profile and the ACC/AHA pooled cohort equations use a fixed set of office-measured variables, while electronic health records now hold years of longitudinal blood pressure, laboratory, medication-fill and comorbidity data these static scores never use.

Objective: To derive and validate an electronic health record-based prognostic model for major adverse cardiovascular events in essential hypertension and compare it against the Framingham profile and the ACC/AHA pooled cohort equations.

Methods: We performed a retrospective cohort study of 8,542 adults with essential hypertension (derivation n=5,979, validation n=2,563), followed a median 5.2 years for a composite of myocardial infarction, stroke, heart failure hospitalization or cardiovascular death, and fit a logistic regression model using blood pressure variability, renal trend, adherence, target-organ damage and comorbidity burden.

Results: The electronic health record model discriminated the outcome better than the pooled cohort equations (C-statistic 0.81 vs 0.74) or the Framingham profile (0.81 vs 0.72, both p<0.001), was well calibrated, and separated five-year event incidence from 3.2% to 28.9% across risk tertiles.

Conclusions: Electronic health record analysis meaningfully improved cardiovascular risk stratification over conventional scores in essential hypertension, supporting external validation as a practical prognostic tool.

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