Clinical Scorecard: Exploring Psychological Influences Beyond the SMART2 Model in Predicting Recurrence of Events in Patients with Atherosclerotic Cardiovascular Disease
At a Glance
Category
Detail
Condition
Atherosclerotic cardiovascular disease with risk of recurrent cardiovascular events
Key Mechanisms
Established SMART2 risk prediction model estimating 10-year risk of recurrent CV events; evaluation of added value of psychological factors (depression, anxiety, insomnia) on risk prediction
Target Population
Patients aged 40–80 years with stable established atherosclerotic cardiovascular disease
Care Setting
Primary and secondary care settings
Key Highlights
Psychological factors (depression, anxiety, insomnia) are prevalent in up to 45% of patients with atherosclerotic cardiovascular disease.
The SMART2 model reliably estimates 10-year risk of recurrent cardiovascular events even in patients with psychological factors.
Adding psychological factors (diagnosis, symptoms, or treatment) to SMART2 does not meaningfully improve risk prediction performance.
Guideline-Based Recommendations
Diagnosis
Use SMART2 model for estimating 10-year risk of recurrent cardiovascular events in patients with established atherosclerotic cardiovascular disease.
Consider psychological factors as potentially modifying risk but not as additive predictors beyond SMART2.
Management
Base treatment decisions on risk estimates from the SMART2 model regardless of presence of depression, anxiety, or insomnia.
Recognize psychological factors may affect treatment adherence but do not alter risk prediction accuracy.
Monitoring & Follow-up
Monitor patients with psychological factors as per standard cardiovascular disease protocols.
No additional monitoring adjustments required based on psychological factors for risk prediction.
Risks
Psychological factors are associated with increased risk of recurrent cardiovascular events but do not improve predictive accuracy beyond SMART2.
Underestimation of risk due to psychological factors is unlikely when using SMART2.
Patient & Prescribing Data
Patients with established atherosclerotic cardiovascular disease, including those with depression, anxiety, or insomnia
Psychological factors are associated with lower prescription rates and adherence to preventive cardiovascular treatments, but their inclusion does not improve risk prediction models.
Clinical Best Practices
Apply the SMART2 risk prediction model for recurrent cardiovascular event risk assessment in patients aged 40–80 with established atherosclerotic cardiovascular disease.
Do not modify risk prediction based on presence or treatment of depression, anxiety, or insomnia as these do not add predictive value beyond SMART2.
Use psychological factor information to support holistic patient care and address treatment adherence rather than to adjust cardiovascular risk estimates.
by Joris Holtrop, Mari Nordbø Gynnild, Toril Dammen, Håvard Dalen, Ingvild Saltvedt, Hanne Ellekjær, Steven H J Hageman, Frank L J Visseren, John William McEvoy, Jannick A N Dorresteijn, John Munkhaugen, On behalf of the UCC-SMART study group
