The Role of Physicians in the Era of Predictive Analytics.

Every day, more information becomes available about factors that affect the risk of a clinical event. Predictive analytics incorporate this information into prognostic models that estimate the likelihood of this event for an individual patient. The Framingham Heart Study pioneered this approach1 and such estimates have become core elements of clinical care and guideline recommendations, such as the recent ACC/AHA guidelines for managing blood cholesterol for primary prevention of cardiovascular disease risk.2 Advances in predictive analytics and precision medicine have and will continue to change the practice of medicine. However, to apply these risk estimates wisely, a physician must understand that the concept of risk is more subtle and complex than is generally appreciated. Specifically, it is important to distinguish between 2 meanings of risk: risk in the epidemiological sense (the risk of a group of individuals) vs risk in the clinical sense (the risk for individual members of the group). But how accurately does the overall risk for the group reflect the risk of each of the individuals who make up the group? This distinction is critical to appreciate because it underlies the essential role that physicians need to play in the era of predictive analytics. In this Viewpoint, cardiovascular risk will be used as an example, but the same concepts can be applied to risk prediction in any context.