New risk score identifies heart disease risk in kidney transplant patients

Using an innovative risk score assessment score, heart researchers at Intermountain Health in Salt Lake City say they can accurately predict whether patients being assessed for kidney transplant will likely have a future major cardiac event, like a heart attack or stroke, according to a new study.

Intermountain Health clinicians regularly review patient data through their electronic health system to determine who may have heart disease without knowing it. Now, in a major new study, Intermountain heart researchers found that using their Intermountain Risk Score (IMRS) they could also accurately predict whether patients being assessed for kidney transplant would have a major cardiac event, like a heart attack or stroke. 

This study demonstrates that we could adapt our already existing risk score guide to help identify which of these patients might also be at risk for having a heart event, which could lead to better and more personalized treatment."

Benjamin Horne, PhD, director of cardiovascular and genetic epidemiology, Intermountain Health

Findings from the new study will be presented at the American Heart Association Scientific Sessions in Chicago on Sunday, November 17, 2024.

The Intermountain Risk Score is a well-validated, sex-specific risk prediction tool that includes factors like age and results from complete blood count and basic metabolic profile testing to predict the risk of major cardiovascular events and death.

These scores are assessed automatically based on information input into electronic health records. If a patient has a high score, their care team is alerted. 

In the Intermountain study, researchers looked specifically at the accuracy of the IMRS for patients being considered for kidney transplant.

They identified patients who were assessed for transplant surgery at Intermountain Health between June 2015 and April 2024 and found 891 patients. 200 patients did not have all of the laboratory tests needed to calculate an IMRS, so they were excluded from the next step in the study.

That left 691 patients with enough information to retroactively calculate IMRS.

Intermountain researchers found that these patients were on average 55.9 years old, and 34.3% were women.

Of those 691 patients, 171 experienced a major cardiac event over a five-year follow-up period. Researchers found that IMRS was effective in predicting these outcomes, showing the potential use of calculating such a score in people being evaluated for kidney transplant.

The score can be "a really valuable piece of information, but some of these patients were missing lab tests that would have enabled us to calculate it," said Dr. Horne, referring to the 200 people in this retrospective study who did not have enough laboratory tests to be included. 

"This is the first step in assessing if we can make a risk score specifically keyed to the risk of people who are going to have a rental transplant, and make sure we collected all the appropriate data so we can do so," he said.

Next steps include validating the risk score in another patient population, determining whether modifying the risk score by adding data routinely collected in kidney patients improves its ability to assess risk for kidney transplant patients, and then conducting a prospective clinical trial of using the risk score in modifying clinical care processes to determine whether personalized care improves patient outcomes.