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Aim To identify existing comorbidity measures and summarise their association with acute coronary syndrome (ACS) outcomes. Methods We searched published studies from MEDLINE (OVIDSP) and EMBASE from inception to March 2021, studies of the pre-specified conference proceedings from Web of Science since May 2017, and studies included in any relevant systematic reviews. Studies that reported no comorbidity measures, no association of comorbid burden with ACS outcomes, or only used a comorbidity measure as a confounder without further information were excluded. After independent screening by three reviewers, data extraction and risk of bias assessment of each included study was undertaken. Results were narratively synthesised. Results Of 4166 potentially eligible studies identified, 12 (combined n=6,885,982 participants) were included. Most studies had a high risk of bias at quality assessment. Six different types of comorbidity measures were identified with the Charlson comorbidity index (CCI) the most widely used measure among studies. Overall, the greater the comorbid burden or the higher comorbidity scores recorded, the greater was the association with the risk of mortality. Conclusion The review summarised different comorbidity measures and reported that higher comorbidity scores were associated with worse ACS outcomes. The CCI is the most widely measure of comorbid burden and shows additive value to clinical risk scores in use.

Objective To compare the performance of risk adjustment models using the Elixhauser and Charlson comorbidity scores in predicting in-hospital outcomes of ACS patients from a nationwide administrative database. Study Design and Setting All hospitalizations for ACS in the United States between 2004 and 2014 (n = 7,201,900) were retrospectively analyzed. We used ECS and CCI score based on ICD-9 codes to define comorbidity variables. Logistic regression models were fitted to three in-hospital outcomes, including mortality, Major Acute Cardiovascular & Cerebrovascular Events (MACCE) and bleeding. The prognostic values of ECS and CCI after adjusting for known confounders, were compared using the C-statistic, Akaike information criterion (AIC), and Bayesian information criterion (BIC). Results The statistical performance of models predicting all in-hospital outcomes demonstrated that the ECS had superior prognostic value compared to the CCI, with higher C-statistics and lower AIC and BIC values associated with the former. Conclusion This is the first study that compared the prognostic value of the ECS and CCI scores in predicting multiple ACS outcomes, based on their scoring systems. Better discrimination and goodness of fit was achieved with the Elixhauser method across all in-hospital outcomes studied.

We assessed the simple view of reading as a framework to explain grade 3 reading comprehension in two ways. We first confirmed that a structural equation model in which word recognition, listening comprehension, and reading comprehension were assessed by multiple measures to inform each latent construct provided an adequate fit to this model in grade 3. Together, these variables explained sizeable (95%) variance in reading comprehension. We next examined how well oral language and code-related skills assessed in prekindergarten (PK) predicted reading comprehension in grade 3, through the two core components of the simple view: word recognition and listening comprehension. Multiple measures of vocabulary, grammar, and discourse-level skills were used to inform a latent construct of PK oral language, and multiple measures of letter and print knowledge and phonological processing informed a latent construct of code-related skills that are precursors to word reading. The best-fitting structural equation model explained 96% of the variance in reading comprehension, with strong relations evident between prekindergarten skills and the complementary grade 3 constructs of listening comprehension and word recognition. Of note, the PK latent constructs of oral language and code-related skills were strongly related to each other, with a much weaker (and non significant) relation between the complementary grade 3 constructs of listening comprehension and word recognition. These findings demonstrate a strong influence of PK oral language skills on later reading comprehension, and provide diagnostic and instructional implications for the teaching of early reading.