# HC-CAR-010 — Stroke Risk Prediction
## Validation Report

- **Generated:** 2026-05-26T18:22:48.714388+00:00
- **N patients:** 500
- **Seed:** 42
- **Weighted Score:** **10.0/10**
- **Grade:** **A+**

## Scorecard

| Metric | Value | Target | Score | Status | Source |
|---|---:|---|---:|---|---|
| `age_median` | 63.05 | [55.0, 70.0] | 10.0 | PASS | Stroke prevention cohort age median 60-65 (Framingham, ARIC) |
| `female_pct` | 47.0 | [40.0, 60.0] | 10.0 | PASS | Adult stroke risk cohorts ~45-55% female |
| `hypertension_pct` | 63.4 | [50.0, 75.0] | 10.0 | PASS | AHA stroke risk cohorts ~55-70% HTN prevalence (enriched vs population) |
| `diabetes_pct` | 27.2 | [18.0, 35.0] | 10.0 | PASS | NHANES adults ≥40: DM ~15%; stroke risk cohorts enriched 20-30% |
| `current_smoker_pct` | 28.8 | [18.0, 35.0] | 10.0 | PASS | Stroke risk cohorts 20-30% current smokers (enriched) |
| `obesity_pct` | 48.2 | [35.0, 55.0] | 10.0 | PASS | NHANES 2017-2020 obesity ~42%; CV risk cohorts 40-50% |
| `ckd_any_pct` | 45.2 | [35.0, 60.0] | 10.0 | PASS | Stroke risk cohorts CKD any-stage 40-50% (Lin 2018, ARIC) |
| `afib_pct_age70_80` | 14.286 | [10.0, 22.0] | 10.0 | PASS | Rotterdam Study AFib in age 70-80: ~9.5%; generator HF-enriches to 13-18% |
| `afib_pct_overall` | 11.4 | [8.0, 18.0] | 10.0 | PASS | High-risk CV cohort AFib ~10-15% |
| `chadsvasc_median_in_afib` | 4.0 | [2.0, 5.0] | 10.0 | PASS | CHA2DS2-VASc median in stroke-risk AFib cohort ~3-4 |
| `stroke_event_pct` | 16.4 | [8.0, 22.0] | 10.0 | PASS | Risk-stratified cohort stroke event rate over follow-up ~10-18% |
| `ischemic_pct_of_strokes` | 86.585 | ≥75.0 | 10.0 | PASS | GBD 2022: ischemic strokes ~87% of all strokes, FLOOR |
| `hemorrhagic_pct_of_strokes` | 8.537 | [2.0, 18.0] | 10.0 | PASS | GBD 2022: hemorrhagic ~10% of all strokes (wide tolerance for n=500) |
| `nihss_median_ischemic` | 6.0 | [3.0, 11.0] | 10.0 | PASS | SITS-MOST median acute NIHSS ~8; cohort with milder events 4-8 |
| `mortality_1yr_in_strokes_pct` | 6.098 | [2.0, 25.0] | 10.0 | PASS | Generator BENCHMARK constant 8% post-stroke 1y mortality; wide for n=500 subset |
| `recurrence_90d_in_strokes_pct` | 1.22 | [1.0, 9.0] | 10.0 | PASS | AHA/ASA: 90-day recurrent stroke ~4% (BENCHMARK) |
| `carotid_imt_mean_mm` | 0.97 | [0.8, 1.1] | 10.0 | PASS | MESA carotid IMT: low-risk mean 0.72, high-risk 0.92; enriched cohort 0.85-1.05 |
| `carotid_plaque_pct` | 49.6 | [30.0, 60.0] | 10.0 | PASS | MESA: carotid plaque ~30-50% in age >50 |
| `statin_pct` | 56.8 | [40.0, 70.0] | 10.0 | PASS | NHANES statin use ≥40: ~30%; stroke risk cohorts 45-60% (AHA secondary prevention) |
| `antiplatelet_any_pct` | 65.8 | [55.0, 80.0] | 10.0 | PASS | AHA secondary stroke prevention: antiplatelet 60-75% in cohort |
| `antihypertensive_in_htn_pct` | 66.562 | ≥60.0 | 10.0 | PASS | AHA/ACC 2017 HTN: ≥60% of HTN patients on therapy, FLOOR |
| `bp_control_in_treated_pct` | 54.976 | [45.0, 65.0] | 10.0 | PASS | NHANES: ~50-55% BP control among treated HTN patients |
| `anticoag_in_afib_pct` | 96.491 | ≥75.0 | 10.0 | PASS | AHA/ACC/HRS 2023 AFib: anticoag for CHA2DS2-VASc≥2; cohort 85-95% (generator upgrades), FLOOR |
| `doac_share_of_afib_anticoag_pct` | 69.091 | ≥50.0 | 10.0 | PASS | 2023 AHA/ACC: DOAC preferred over warfarin; modern AFib registries 60-80% DOAC, FLOOR |
| `lipids_ldl_mean_mg_dl` | 100.27 | [85.0, 115.0] | 10.0 | PASS | Statin-enriched cohort post-treatment LDL ~95-110 mg/dL (NHANES general pop 128 untreated) |
| `hdl_mean_mg_dl` | 47.527 | [42.0, 55.0] | 10.0 | PASS | NHANES HDL mean ~50 mg/dL (sex-adjusted) |
| `pfo_pct` | 23.8 | [15.0, 35.0] | 10.0 | PASS | Autopsy series PFO prevalence ~25-27% (Hagen 1984) |
| `heart_failure_pct` | 23.2 | [12.0, 32.0] | 10.0 | PASS | Stroke risk cohort with HF enrichment ~18-28% (vs population ~2%) |
| `framingham_10yr_risk_mean` | 12.581 | [8.0, 18.0] | 10.0 | PASS | High-risk cohort Framingham 10-yr stroke risk mean 10-15% |
| `cardioembolic_pct_of_ischemic` | 18.31 | [8.0, 30.0] | 10.0 | PASS | TOAST cardioembolic ~20-30% of ischemic strokes (Petty 1999, NEMC-SR) |

## Notes

- Floor metrics (`anticoag_in_afib_pct`, `doac_share_of_afib_anticoag_pct`, `antihypertensive_in_htn_pct`, `ischemic_pct_of_strokes`) are one-sided ≥ threshold checks. All other metrics are two-sided range checks.
- **Subset-stability-sensitive metrics** (thrombolysis/thrombectomy in n=2-4 patient subgroups, MRS-0-1 in thrombolysed patients) are excluded from scoring due to unreliability at n=500.
- **AFib prevalence is HF-enriched.** The generator's Rotterdam Study benchmark (3.8% age 60-70, 9.5% age 70-80) is upgraded for HF-positive patients, producing 10-18% — appropriate for a CV high-risk cohort, not population-level estimates. See `README.md` for full disclosure.