Thesis (MCur)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: Coronary artery disease is a form of cardiovascular disease (CVD) which
manifests itself in three ways: angina pectoris, acute coronary syndrome and cardiac death.
Thirty-three people die daily of a myocardial infarction (cardiac death) and 7.5 million deaths
annually are caused by CVD (51% from strokes and 45% from coronary artery disease)
worldwide. Globally, the CVD death rate is a mere 4% compared to South Africa which has a
42% death rate. It is predicted that by the year 2030 there will be 25 million deaths annually
from CVD, mainly in the form of strokes and heart disease. The WHO compared the death
rates of high-income countries to those of low- and middle-income countries, like South
Africa, and the results show that CVD deaths are declining in high-income countries but
rapidly increasing in low- and middle-income countries. Although there are several risk
prediction tools in use worldwide, to predict ischemic risk, South Africa does not use any of
these tools. Current practice in South Africa to diagnose acute coronary syndrome is the use
of a physical examination, ECG changes and positive serum cardiac maker levels.
Internationally the same practice is used to diagnose acute coronary syndrome but risk
assessment tools are used additionally to this practise because of limitations of the ECG and
serum cardiac markers when it comes to NSTE-ACS.
Objective: The aim of this study was to systematically appraise evidence on the accuracy of
acute coronary syndrome risk prediction tools in adults.
Methods: An extensive literature search of studies published in English was undertaken.
Electronic databases searched were Cochrane Library, MEDLINE, Embase and CINAHL.
Other sources were also searched, and cross-sectional studies, cohort studies and
randomised controlled trials were reviewed. All articles were screened for methodological
quality by two reviewers independently with the QUADAS-2 tool which is a standardised
instrument. Data was extracted using an adapted Cochrane data extraction tool. Data was
entered in Review Manager 5.2 software for analysis. Sensitivity and specificity was
calculated for each risk score and an SROC curve was created. This curve was used to
evaluate and compare the prediction accuracy of each test.
Results: A total of five studies met the inclusion criteria of this review. Two HEART studies
and three GRACE studies were included. In all, 9 092 patients participated in the selected
studies. Estimates of sensitivity for the HEART risks score (two studies, 3268 participants)
were 0,51 (95% CI 0,46 to 0,56) and 0,68 (95% CI 0,60 to 0,75); specificity for the HEART
risks score was 0,90 (95% CI 0,88 to 0,91) and 0,92 (95% CI 0,90 to 0,94). Estimates of
sensitivity for the GRACE risk score (three studies, 5824 participants) were 0,03 (95% CI0,01 to 0,05); 0,20 (95% CI 0,14 to 0,29) and 0,79 (95% CI 0,58 to 0,93). The specificity was
1,00 (95% CI 0,99 to 1,00); 0,97 (95% CI 0,95 to 0,98) and 0,78 (95% CI 0,73 to 0,82). On
the SROC curve analysis, there was a trend for the GRACE risk score to perform better than
the HEART risk score in predicting acute coronary syndrome in adults.
Conclusion: Both risk scores showed that they had value in accurately predicting the
presence of acute coronary syndrome in adults. The GRACE showed a positive trend
towards better prediction ability than the HEART risk score. / AFRIKAANSE OPSOMMING: Agtergrond: Koronêre bloedvatsiekte is ‘n vorm van kardiovaskulêre siekte. Koronêre
hartsiekte manifesteer in drie maniere: angina pectoris, akute koronêre sindroom en
hartdood. Drie-en-dertig mense sterf daagliks aan ‘n miokardiale infarksie (hartdood). Daar
is 7,5 miljoen sterftes jaarliks as gevolg van kardiovaskulêre siektes (51% deur beroertes en
45% as gevolg van koronêre hartsiektes) wêreldwyd. Globaal is die sterfte syfer as gevolg
van koronêre vaskulêre siekte net 4% in vergelyking met Suid Afrika, wat ‘n 42% sterfte
syfer het. Dit word voorspel dat teen die jaar 2030 daar 25 miljoen sterfgevalle jaarliks sal
wees, meestal toegeskryf aan kardiovaskulêre siektes. Die hoof oorsaak van sterfgevalle sal
toegeskryf word aan beroertes en hart siektes. Die WHO het die sterf gevalle van hoeinkoms
lande vergelyk met die van lae- en middel-inkoms lande, soos Suid Afrika, en die
resultate het bewys dat sterf gevalle as gevolg van kardiovaskulêre siekte is besig om te
daal in hoe-inkoms lande maar dit is besig om skerp te styg in lae- en middel-inkoms lande.
Daar is verskeie risiko-voorspelling instrumente wat wêreldwyd gebruik word om isgemiese
risiko te voorspel, maar Suid Afrika gebruik geen van die risiko-voorspelling instrumente nie.
Huidiglik word akute koronêre sindroom gediagnoseer met die gebruik van n fisiese
ondersoek, EKG verandering en positiewe serum kardiale merkers. Internationaal word die
selfde gebruik maar risiko-voorspelling instrumente word aditioneel by gebruik omdat daar
limitasies is met EKG en serum kardiale merkers as dit by NSTE-ACS kom.
Doelwit: Die doel van hierdie sisematiese literatuuroorsig was om stelselmatig die bewyse
te evalueer oor die akkuraatheid van akute koronêre sindroom risiko-voorspelling
instrumente vir volwassenes.
Metodes: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was
onderneem. Cochrane biblioteek, MEDLINE, Embase en CINAHL databases was deursoek.
Ander bronne is ook deursoek. Die tiepe studies ingesluit was deurnsee-studies,
kohortstudies en verewekansigde gekontroleerde studies. Alle artikels is onafhanklik vir die
metodologiese kwaliteit gekeur deur twee beoordeelaars met die gebruik van die QUADAS-2
instrument, ‘n gestandaardiseerde instrument. ‘n Aangepaste Cochrane data instrument is
gebruik om data te onttrek. Data is opgeneem in Review Manager 5.2 sagteware vir
ontleding. Sensitiwiteit en spesifisiteit is bereken vir elke risiko instrument en ‘n SROC kurwe
is geskep. Die SROC kurwe is gebruik om die akkuraatheid van voorspelling van elke
instrument te evalueer en te toets.
Resultate: Twee HEART studies en drie GRACE studies is ingesluit. In total was daar 9 092
patiente wat deelgeneeem het in die gekose studies. Skattings van sensitiwiteit vir die HEART risiko instrument (twee studies, 3268 deelnemers) was 0,51 (95% CI 0,47 to 0,56)
en 0,68 (95% CI 0,60 to 0,75) spesifisiteit vir die HEART risiko instrument was 0,89 (95% CI
0,88 to 0,91) en 0,92 (95% CI 0,90 to 0,94). Skattings van sensitiwiteit vir die GRACE risiko
instrument (drie studies, 5824 deelnemers) was 0,28 (95% CI 0,13 to 0,53); 0,20 (95% CI
0,14 to 0,29) en 0,79 (95% CI 0,58 to 0,93). Die spesifisiteit vir die GRACE risiko instrument
was 0,97 (95% CI 0,95 to 0,99); 0,97 (95% CI 0,95 to 0,98) en 0,78 (95% CI 0,73 to 0,82).
Met die SROC kurwe ontleding was daar ‘n tendens vir die GRACE risiko instrument om
beter te vaar as die HEART risiko instrument in die voorspelling van akute koronêre
sindroom in volwassenes.
Gevolgtrekking: Altwee risiko instrumente toon aan dat albei instrumente van waarde is.
Albei het die vermoë om die teenwoordigheid van akute koronêre sindroom in volwassenes
te voorspel. Die GRACE toon ‘n positiewe tendens teenoor beter voorspelling vermoë as die
HEART risiko instrument.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/97069 |
| Date | 04 1900 |
| Creators | Van Zyl, Johet Engela |
| Contributors | Khondowe, Oswell, Stellenbosch University. Faculty of Health Sciences. Interdisciplinary Health Sciences. Nursing. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 85 pages : illustrations |
| Rights | Stellenbosch University |
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