Development and external validation of risk scores for cardiovascular hospitalization and rehospitalization in patients with diabetes

Context Cardiovascular disease (CVD) is a common and costly reason for hospitalisation and re-hospitalisation among patients with type 2 diabetes.

Objective This study aimed to develop and externally validate two risk prediction models for cardiovascular hospitalisation and cardiovascular re-hospitalisation.

Design Two independent prospective cohorts.

Setting The derivation cohort includes 4,704 patients with type 2 diabetes from 18 general practices in Cambridgeshire. The validation cohort comprises 1,121 patients with type 2 diabetes from post-trial follow-up data.

Main Outcome Measure Cardiovascular hospitalisation over 2 years and cardiovascular re-hospitalisation after 90 days of the prior CVD hospitalisation.

Results The absolute rate of cardiovascular hospitalisation and re-hospitalisation was 12.5% and 6.7% in the derivation cohort, and 16.3% and 7.0% in the validation cohort. Discrimination of the models was similar in both cohorts, with C statistics above 0.70, and excellent calibration of observed and predicted risks.

Conclusion Two new prediction models that quantify risks of cardiovascular hospitalisation and re-hospitalisation have been developed and externally validated. They are based on a small number of clinical measurements that are available for patients with type 2 diabetes in many developed countries in primary care settings and could serve as the tools to screen the population at high risk of cardiovascular hospitalisation and re-hospitalisation.