Differences in the Cardiovascular Risk Assessment in Cardiology Outpatients in Mali: Comparison between Framingham Body Mass Index-Based Tool and Low-Information World Health Organization Chart

Objective. This study aimed to compare 2 laborless tools, namely, the body mass index-based Framingham (bmi-Frm) and low-information WHO- (li-WHO-) based risk scores, and assess their agreement in outpatients in a cardiology department. Methodology. Data stem from a cross-sectional previous study performed from May to September 2016 in the Cardiology Department of University Hospital Gabriel Toure (UH-GT) in Bamako. All patients aged 40 and more were included in the study allowing the assessment of bmi-Frm and li-WHO prediction charts. The cardiovascular risk (CVR) was evaluated using a calculator prepared by D‘Agostino et al. for the bmi-Frm and the li-WHO chart for the Afro-D region of the WHO. The risk score for both ranged from was considered the statistical significance level. After sample description, the risk score was assessed using bmi-Frm and li-WHO prediction tools. Finally, a kappa test was performed to check for the interreliability of both methods. For weighted kappa, coefficients were given all five classes of risk groups in 0, 25 steps from 1 for total concordance to 0 for total discordance. Results. This study involved 793 outpatients, 63.7% being female, 35.1% of them younger than 50 years, 57.9% with no formal education, and 67.7% with no medical insurance. Means for age, body mass index (BMI), and systolic blood pressure (SBP) were, respectively, 53.81 ± 16.729 years, 25.29 ± 06.151 kg/m2, and 139.49 ± 27.110 mm Hg. Using the li-WHO prediction chart gives a much higher proportion of low-risk patients compared to bmi-Frm (83.6 vs. 37.7). Sociodemographic characteristics such as education or income level were not different in risk score neither for the bmi-Frm nor for the li-WHO risk score. The percentage of agreement between both tools was 40.4%, and agreement (kappa of 0.1 and weighted kappa of 0.2) was found to be slight. Conclusion. Using the bmi-Frm and li-WHO tool gives a similar risk estimation in younger female patients. Older patients must be evaluated using high-information tools with cholesterol, e.g., versions of the Framingham risk equation or WHO using cholesterol. These must be confirmed in further studies and compared to data from prospective studies