Highlights
- •ICHRON predicted a 3-year chronic disease among an Australian validation cohort.
- •ICHRON is valuable for primary care patients in distinct locales.
- •ICHRON was found to be more predictive among Aboriginal and Torres Islanders.
- •ICHRON can be calculated within the EHR using standardized laboratory parameters.
Abstract
Background
The Intermountain Chronic Disease Risk Score (ICHRON) is a primary prevention risk
prediction tool that uses commonly ordered blood tests and is designed to be calculated
by the electronic health record. ICHRON was highly predictive of 3-year chronic disease
(ChrD) diagnosis in an internal validation; however, external validation is needed.
Methods
ICHRON was calculated among patients from a region of Australia using sex-specific
weightings of age and components of the comprehensive metabolic panel and the complete
blood count. Original ICHRON weightings and risk stratification thresholds from the
US-based derivation at Intermountain Healthcare were used. ICHRON was evaluated as
a predictor of an incident 3-year ChrD diagnosis (coronary artery disease, myocardial
infarction, heart failure, atrial fibrillation, stroke, dementia, diabetes, renal
failure, chronic obstructive pulmonary disease, and peripheral vascular disease).
Results
A total 5,512 females (49.6 ± 19.2) and 3,461 males (53.0 ± 18.6) were studied. Among
females, 50.3%, 33.7% and 16.0% were low, moderate, and high-risk, respectively; and
for males, 39.6%, 35.0%, and 25.4%. Frequency of a 3-year ChrD diagnosis among females
was 2.2%, 8.5%, and 15.9% for low, moderate, and high-risk groups, respectively, and
4.7%, 9.7%, and 20.0% among males. C-statistics were 0.726 (0.700, 0.752) for females
and 0.694 (0.665, 0.724) for males.
Conclusion
ICHRON predicted ChrD diagnosis at 3-years among an external, geographically distant
validation cohort. These findings show the value of ICHRON for primary care patients
in distinct locales. Additionally, electronic calculation of ICHRON empowers the clinical
use of this tool to identify and differentially manage and treat high-risk patients.
Keywords
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Article info
Publication history
Published online: June 17, 2020
Accepted:
June 6,
2020
Received in revised form:
May 25,
2020
Received:
February 11,
2020
Identification
Copyright
© 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
