Abstract Aims To assess how population ageing and functional health trends could shape the number and proportion of older adults living with cardiovascular disease (CVD) and severe dependency in activities of daily living (ADL) across the EU27 by 2050. Methods and results A prevalence-based macrosimulation combined Eurostat population projections, Global Burden of Disease 2023 CVD prevalence and trends, and European Health Interview Survey ADL data. Reference assumptions included within-stratum independence between CVD and dependency, constant age-specific ADL rates and no dependency gradient within ages ≥75 years. Decomposition and sensitivity analyses examined demographic, epidemiological and functional contributions; uncertainty propagation was incomplete. From 2021 to 2050, the population aged ≥65 years with CVD was projected to increase from 44.1 to 59.2 million (+34.3%). Modelled co-occurrence with severe ADL dependency, not dependency attributable to CVD, increased from 4.06 to 6.21 million (+53.0%), raising the proportion from 9.2% to 10.5%. Demographic change drove the increase in number, partly offset by declining CVD prevalence. Under reference assumptions, annual relative ADL declines of 0.45% and 1.46% would stabilise the proportion and number, respectively. A post hoc continuation of EHIS declines, using fixed country and sex weights under the same CVD trajectory, instead reduced the number to 3.61 million (−11.1%) and the proportion to 6.1%. Conclusion Severe ADL dependency could increase faster than the older cardiovascular population, but sustained functional improvements could reverse this trajectory. Cardiovascular care planning should account for both population growth and changing functional health.
Abstract Aims This scoping review aimed to comprehensively map the landscape of prediction models for predicting cardiovascular disease (CVD) risk in the general population over the past two decades, including model development, validation, updating, and impact assessment. Methods PubMed, Web of Science, and Embase databases were searched from January 2006 to November 2025 for studies that developed, validated, updated, or assessed the impact of at least one CVD risk prediction model in the general population. Two reviewers independently screened studies and extracted data on general characteristics, justification, methodological characteristics, and reporting characteristics. Findings were summarized descriptively. Results We included 322 studies, comprising 220 development studies (yielding 298 models), 94 independent validation or update studies, and eight studies providing nine impact assessments involving seven models. Of the 220 development studies, 90.0% cited at least one existing model; the most frequently cited justification was insufficient predictors (44.4%). Among the 298 models, 86.6% had undergone internal validation, while external validation (43.0%), updating (8.7%), and impact assessment (2.3%) remained low. Reporting completeness varied: 82.3% reported both discrimination and calibration, 49.4% provided full model specification, and 51.1% offered a practical tool. Notably, only 24.3% of models published after 2015 cited the TRIPOD guideline. Only 11.1% were reported to be recommended in clinical guidelines. Conclusion Despite a substantial increase in CVD prediction model development, critical gaps persist in external validation, reporting transparency, and clinical impact assessment. Future research should prioritize strengthening the evidence base of existing models through rigorous validation, transparent reporting, and implementation research.
Aims Accurate risk stratification for patients with three-vessel coronary artery disease (3VD) undergoing percutaneous coronary intervention (PCI) remains important in contemporary practice. Synergy between PCI with Taxus and cardiac surgery (SYNTAX)-based mortality prediction models require reassessment in modern PCI populations.Methods and results This post hoc analysis of the Multivessel TALENT trial evaluated the core and extended logistic clinical SYNTAX Score (LCSS) for predicting 1-year all-cause mortality. Discrimination was assessed using the area under the receiver-operating characteristic curve (AUC), and calibration using calibration intercept, calibration slope, graphical calibration, and the E-statistic. Prediction scores were calculated within each of 20 imputed datasets, with model performance evaluated within each imputation and summarized across imputations. Intercept-and-slope recalibration and decision curve analysis were also performed. At 1 year, 46 (3.0%) of 1548 enrolled patients had died. The pooled AUCs were 0.716 for the LCSS core model and 0.744 for the extended model, compared with 0.629 for the anatomical SYNTAX Score and 0.632 for the functional SYNTAX Score. LCSS models systematically overestimated absolute risk, although observed mortality increased across predicted-risk quintiles. Decision curve analysis showed a positive net benefit for the original and recalibrated LCSS models across threshold probabilities of 1-10%, with numerically higher net benefit for the recalibrated extended model across much of the evaluated threshold range.Conclusion In contemporary PCI for 3VD, the LCSS showed moderate discrimination for 1-year all-cause mortality while overestimating its absolute risk. Recalibration improved agreement with observed risk in this cohort and may inform future validation and model refinement.
