Most clinicians in cardiology use an online portal such as HeartScore (https://www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/HeartScore) or CAD consortium (https://qxmd.com/calculate/calculator_287/pre-test-probability-of-cad-cad-consortium) to calculate a risk score for a patient.

As risk scores continue to evolve and change overtime, it can be a tedious process to recalculate the risk score of many patients as these online portal could only do so one patient at a time.

While there are R package such as CVrisk (https://cran.r-project.org/web/packages/CVrisk/index.html), RiskScorescvd (https://cran.r-project.org/web/packages/RiskScorescvd/index.html) and preventR (https://cran.r-project.org/web/packages/preventr/index.html) dedicated to calculating a patient’s risk of having cardiovascular disease (stroke, heart attack), there is no R package that is dedicated to calculating pretest risk scores for obstructive CAD.

Pretest score for CAD are more useful than risk score for cardiovascular diseases (stroke, heart attack) as early detection and intervention treatment of CAD can lead to better outcomes.

An R package called pretestcad (https://cran.r-project.org/web/packages/pretestcad/index.html) was made to fill this gap, allowing users to calculate these scores () automatically for many patients, prior to deciding if the patient should go for CT scan or invasive coronary angiography to confirm

Examples of such scores are the 2017 PROMISE Minimal-Risk Score and the 2020 Winther et. al. Risk-Factor-weighted Clinical Likelihood (RF-CL) and Coronary Artery Calcium Score-Weighted Clinical Likelihood (CACS-CL) PTP which was recommended to be used in the 2024 ESC Guidelines (https://academic.oup.com/eurheartj/article/45/36/3415/7743115).
Jeremy Selva
National Heart Centre Singapore
An R package to consolidate pretest probability models and guidelines for CAD
Most clinicians in cardiology use an online portal such as HeartScore (https//www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/HeartScore) or CAD consortium (https//qxmd.com/calculate/calculator_287/pre-test-probability-of-cad-cad-consortium) to calculate a risk score for a patient.  As risk scores continue to evolve and change overtime, it can be a tedious process to recalculate the risk score of many patients as these online portal could only do so one patient at a time.  While there are R package such as CVrisk (https//cran.r-project.org/web/packages/CVrisk/index.html), RiskScorescvd (https//cran.r-project.org/web/packages/RiskScorescvd/index.html) and preventR (https//cran.r-project.org/web/packages/preventr/index.html) dedicated to calculating a patient’s risk of having cardiovascular disease (stroke, heart attack), there is no R package that is dedicated to calculating pretest risk scores for obstructive CAD.  Pretest score for CAD are more useful than risk score for cardiovascular diseases (stroke, heart attack) as early detection and intervention treatment of CAD can lead to better outcomes.  An R package called pretestcad (https//cran.r-project.org/web/packages/pretestcad/index.html) was made to fill this gap, allowing users to calculate these scores () automatically for many patients, prior to deciding if the patient should go for CT scan or invasive coronary angiography to confirm  Examples of such scores are the 2017 PROMISE Minimal-Risk Score and the 2020 Winther et. al. Risk-Factor-weighted Clinical Likelihood (RF-CL) and Coronary Artery Calcium Score-Weighted Clinical Likelihood (CACS-CL) PTP which was recommended to be used in the 2024 ESC Guidelines (https//academic.oup.com/eurheartj/article/45/36/3415/7743115).