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Cleveland Clinic and The MetroHealth System Receive Grant to Enhance Heart Disease Risk Calculators

$2.2 Million National Institute on Aging Award to Develop New Model Incorporating Environmental and Neighborhood-Level Characteristics

Following its study showing that current clinical prediction models underestimate cardiovascular risk in socioeconomically disadvantaged neighborhoods, a research team led by investigators from Cleveland Clinic and The MetroHealth System has been awarded a $2.2 million National Institute on Aging grant to reduce health disparities for patients at risk for heart disease.

The award supports the development of a comprehensive risk calculator that incorporates an individual’s clinical risk factors in addition to environmental and neighborhood-level characteristics to better predict major cardiovascular disease, such as stroke and heart attack. Current risk assessment tools rely on clinical indicators alone such as weight, age and smoking history, and do not consider factors associated with where patients live.

“Poorer Americans are more likely to suffer from heart attacks and stroke, and are expected to live 10 fewer years than wealthier Americans,” said Jarrod Dalton, Ph.D., of Cleveland Clinic’s Lerner Research Institute and co-primary investigator of the grant. “Accurate risk assessment is critical for identifying high-risk patients so that prevention strategies or targeted therapies can be used. We aim to understand better the complexity of residential, economic and clinical factors, and how they contribute to cardiovascular disease risk.”

The four-year grant is based on the team’s recently published paper in Annals of Internal Medicine analyzing electronic health data of nearly 110,000 Cleveland Clinic patients. The team found that current models severely underestimate risk in socioeconomically disadvantaged neighborhoods.

The study showed that in patients from poorer communities, major cardiovascular events occurred at more than twice the rates predicted by existing risk assessment tools. According to the researchers, socioeconomic inequalities in healthcare are complex and could be related to barriers such as environmental exposure to toxins, financial stress, less healthy eating options and lack of safe places to exercise.

To develop the statistical model, the team will establish a new combined research registry based on electronic health records of more than 200,000 Cleveland Clinic and MetroHealth patients. They will supplement that data with neighborhood-level information from the U.S. Census Bureau and other government organizations. They will overlay this data to build a new comprehensive, systems-based tool for risk prediction.

“Cardiovascular disease remains the leading cause of death for most Americans,” said MetroHealth’s Adam T. Perzynski, Ph.D., co-principal investigator. “Our collaboration on this project will help healthcare providers identify which of their patients could have poor heart disease outcomes. By incorporating non-clinical factors related to where people live, we can enhance personalized approach and target more effective interventions for specific subpopulations, and, ultimately reduce health disparities.”

The research team includes faculty from Case Western Reserve University School of Medicine and the Jack, Joseph and Morton Mandel School of Applied Social Sciences. The NIA grant number is R01AG055480.

About The MetroHealth System

The MetroHealth System is an essential health system committed to providing health care to everyone in Cuyahoga County, Ohio, and improving the health of the community overall. Its 7,500 employees deliver care to everyone at its main campus, just west of downtown Cleveland, and at more than 20 other MetroHealth locations. Two new hospitals have recently opened in Cleveland Heights and Parma, and MetroHealth also provides health care at more than 40 additional sites in Cuyahoga County through community partnerships.

MetroHealth is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992 by the Committee on Trauma of the American College of Surgeons, and one of two adult and pediatric burn centers in the state of Ohio verified by the American Burn Association. MetroHealth also is home to a verified Level II Pediatric Trauma Center.

In the past year, MetroHealth provided more than 1.4 million patient visits in its hospital and health centers. MetroHealth is also an academic medical center committed to teaching and research; each of its active physicians holds a faculty appointment at Case Western Reserve University School of Medicine. MetroHealth has earned Magnet status, which places it in the top six percent of all hospitals nationwide for nursing excellence.

MetroHealth’s mission is, “Leading the way to a healthier you and a healthier community through service, teaching, discovery and teamwork.” For more information, visit