心血管疾病风险早期预警评估工具的范围综述

Early Warning Assessment Tools for Cardiovascular Disease Risk:a Scoping Review

背景心血管疾病是全球人类死亡的重要原因,其发病隐匿、病情复杂多变,预后不佳。早期识别并积极干预潜在危重患者对改善患者预后至关重要。目的对国内外心血管疾病风险早期预警评估工具研究进行范围综述,总结分析其评估内容及应用情况,为我国心血管疾病患者早期预警评估工具的选择提供参考。方法以范围综述方法学框架为指导,系统检索中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library、Embase、CINAHL、Scopus数据库。检索时限为建库至2023年5月。由2名研究者独立筛选文献和提取资料,从评估内容、研究对象、验证方法、信效度以及预测效能等方面进行分析。结果共纳入16篇文献,其中7篇关于评估工具的开发验证,9篇关于评估工具的本土化应用,涉及20个心血管疾病风险早期预警评估工具。分析结果表明,各评估工具均包含3~17个评估内容,其中出现频率较高的是年龄、收缩压、呼吸频率、血氧饱和度、心率、合并症、意识水平以及性别。2篇文献的信效度检验结果表明信度、效度良好,其他研究均缺少信效度评价。10篇文献报告了评估工具的曲线下面积(AUC),AUC为0.550~0.9269。结论心血管疾病风险早期预警评估工具种类多样,但质量仍有不足,缺少特异性评估工具。未来仍需要进一步验证现有工具的信效度,并结合疾病特征开发本土化且具备良好信效度的心血管专科早期预警评估工具。

Background Cardiovascular disease(CVD)is a major cause of human mortality worldwide,characterized by its insidious onset,intricate and variable course,and poor prognosis.Early identification and active intervention of potentially critically ill patients is essential to improve their prognosis.Objective To conduct a scoping review of the research on early warning assessment tools for cardiovascular disease risk at home and abroad,summarize and analyze their assessment content and application,ultimately providing reference for the selection of appropriate early warning tools for cardiovascular disease patients in China.Methods CNKI,Wanfang Data,VIP,CBM,PubMed,Web of Science,Cochrane Library,Embase,CINAHL,and Scopus were systematically searched from inception to May 2023.Two investigators independently screened literature and extracted data,analyzed in terms of assessment content,study subjects,validation method,reliability and validity,and predictive efficacy.Results A total of 16 papers were included,comprising 7 papers on the development and validation of assessment tools and 9 papers on the localized application of these tools,involving 20 early warning assessment tools for cardiovascular disease risk.The results of the analysis showed that each assessment tool contained 3 to 17 assessment items,with the most frequently mentioned items of age,systolic blood pressure,respiratory rate,oxygen saturation,heart rate,comorbidities,level of consciousness,and gender.The results of the reliability and validity tests for 2 papers indicated robust reliability and validity,while all other studies lacked reliability and validity evaluations.Ten papers reported the area under the curve(AUC),with values ranging from 0.550 to 0.9269.Conclusion Diverse early warning assessment tools for cardiovascular disease risk are available,however,their overall quality remains to be improved and there is a lack of specific assessment tools.In the future,it is imperative to conduct further validations of the reliability and validity of the existing tools,and develop localized early warning assessment tools specialized for cardiovascular diseases considering the unique characteristics of the disease,which exhibit robust reliability and validity.