feat: Implement SCORE2 cardiovascular risk assessment algorithm

.github/workflows/claude-code-review.yml

@@ -17,14 +17,14 @@ jobs:
     #   github.event.pull_request.user.login == 'external-contributor' ||
     #   github.event.pull_request.user.login == 'new-developer' ||
     #   github.event.pull_request.author_association == 'FIRST_TIME_CONTRIBUTOR'
-    
+
     runs-on: ubuntu-latest
     permissions:
       contents: read
       pull-requests: read
       issues: read
       id-token: write
-    
+
     steps:
       - name: Checkout repository
         uses: actions/checkout@v4
@@ -39,7 +39,7 @@ jobs:
 
           # Optional: Specify model (defaults to Claude Sonnet 4, uncomment for Claude Opus 4)
           # model: "claude-opus-4-20250514"
-          
+
           # Direct prompt for automated review (no @claude mention needed)
           direct_prompt: |
             Please review this pull request and provide feedback on:
@@ -48,31 +48,30 @@ jobs:
             - Performance considerations
             - Security concerns
             - Test coverage
-            
+
             Be constructive and helpful in your feedback.
 
           # Optional: Use sticky comments to make Claude reuse the same comment on subsequent pushes to the same PR
           # use_sticky_comment: true
-          
+
           # Optional: Customize review based on file types
           # direct_prompt: |
           #   Review this PR focusing on:
           #   - For TypeScript files: Type safety and proper interface usage
           #   - For API endpoints: Security, input validation, and error handling
           #   - For React components: Performance, accessibility, and best practices
           #   - For tests: Coverage, edge cases, and test quality
-          
+
           # Optional: Different prompts for different authors
           # direct_prompt: |
-          #   ${{ github.event.pull_request.author_association == 'FIRST_TIME_CONTRIBUTOR' && 
+          #   ${{ github.event.pull_request.author_association == 'FIRST_TIME_CONTRIBUTOR' &&
           #   'Welcome! Please review this PR from a first-time contributor. Be encouraging and provide detailed explanations for any suggestions.' ||
           #   'Please provide a thorough code review focusing on our coding standards and best practices.' }}
-          
+
           # Optional: Add specific tools for running tests or linting
           # allowed_tools: "Bash(npm run test),Bash(npm run lint),Bash(npm run typecheck)"
-          
+
           # Optional: Skip review for certain conditions
           # if: |
           #   !contains(github.event.pull_request.title, '[skip-review]') &&
           #   !contains(github.event.pull_request.title, '[WIP]')
-

.github/workflows/claude.yml

@@ -39,26 +39,25 @@ jobs:
           # This is an optional setting that allows Claude to read CI results on PRs
           additional_permissions: |
             actions: read
-          
+
           # Optional: Specify model (defaults to Claude Sonnet 4, uncomment for Claude Opus 4)
           # model: "claude-opus-4-20250514"
-          
+
           # Optional: Customize the trigger phrase (default: @claude)
           # trigger_phrase: "/claude"
-          
+
           # Optional: Trigger when specific user is assigned to an issue
           # assignee_trigger: "claude-bot"
-          
+
           # Optional: Allow Claude to run specific commands
           # allowed_tools: "Bash(npm install),Bash(npm run build),Bash(npm run test:*),Bash(npm run lint:*)"
-          
+
           # Optional: Add custom instructions for Claude to customize its behavior for your project
           # custom_instructions: |
           #   Follow our coding standards
           #   Ensure all new code has tests
           #   Use TypeScript for new files
-          
+
           # Optional: Custom environment variables for Claude
           # claude_env: |
           #   NODE_ENV: test
-

.gitignore

@@ -211,4 +211,3 @@ __marimo__/
 CLAUDE.md
 AGENTS.md
 .aider*
-specs

specs/coding_style.md

@@ -0,0 +1,112 @@
+# Python Coding Style Specification
+
+## Core Principles
+
+### 1. Favor Simplicity Over Complexity
+- **Always choose the simple, straightforward solution** over complex or "sophisticated" alternatives
+- **Avoid over-engineering** - resist the urge to build elaborate abstractions unless clearly needed
+- **No premature optimization** - especially avoid blind optimization without measurement
+- **Use simple building blocks** that can be composed elegantly rather than complex features
+- **Principle**: If there are two ways to solve a problem, choose the one that is easier to understand
+
+### 2. Clarity is Key
+- **Readable code beats clever code** - optimize for the reader, not the writer
+- **Use clear, descriptive names** for variables, functions, and classes
+- **Format code for maximal scanning ease** - use whitespace and structure intentionally
+- **Document intent and organization** with comments and docstrings where helpful
+- **Reduce cognitive load** - code should express intent clearly at a glance
+- **Principle**: The easier your code is to understand immediately, the better it is
+
+### 3. Write Pythonic Code
+- **Follow Python community standards and idioms** for naming, formatting, and programming paradigms
+- **Cooperate with the language** rather than fighting it
+- **Leverage Python features** like generators, itertools, collections, and functional programming
+- **Write code that looks like Python wrote it** - use established patterns and conventions
+- **Examples of Pythonic patterns**:
+  - List comprehensions over explicit loops when appropriate
+  - Context managers (`with` statements) for resource management
+  - Generator expressions for memory efficiency
+  - `enumerate()` instead of manual indexing
+  - `zip()` for parallel iteration
+
+### 4. Don't Repeat Yourself (DRY)
+- **Avoid code duplication** to make code more maintainable and extendable
+- **Use functions and modules** to encapsulate common logic in single authoritative locations
+- **Consider inheritance** to avoid duplicate code between related classes
+- **Leverage language features** like default arguments, variable argument lists (`*args`, `**kwargs`), and parameter unpacking
+- **Eliminate duplication through abstraction** - but don't abstract too early
+
+### 5. Focus on Readability First
+- **PEP8 is a guide, not a law** - readability trumps mechanical adherence to style rules
+- **Make code as easy to understand as possible** - this is the ultimate goal
+- **Deliberately violate guidelines** if it makes specific code more readable
+- **Consider the human reader** first when making formatting and style decisions
+- **Principle**: Rules serve readability, not the other way around
+
+### 6. Embrace Conventions
+- **Follow established conventions** to eliminate trivial decision-making
+- **Use PEP8 as a baseline** but prioritize readability when there's conflict
+- **Establish consistent patterns** in your codebase for common tasks:
+  - Variable naming patterns
+  - Exception handling approaches
+  - Logging configuration
+  - Import organization
+- **Consistency enables focus** - familiar patterns let readers focus on logic rather than parsing
+
+## Specific Implementation Guidelines
+
+### Naming Conventions
+- **Variables and functions**: `snake_case`
+- **Classes**: `PascalCase`
+- **Constants**: `UPPER_SNAKE_CASE`
+- **Private attributes**: `_single_leading_underscore`
+- **Choose descriptive names** that clearly indicate purpose and content
+
+### Code Structure
+- **Organize imports** in this order: standard library, third-party, local imports
+- **Use blank lines** to separate logical sections
+- **Keep functions focused** on a single responsibility
+- **Prefer composition over inheritance** when appropriate
+- **Write functions that do one thing well**
+
+### Documentation
+- **Write docstrings** for modules, classes, and functions that aren't immediately obvious
+- **Use comments** to explain why, not what
+- **Keep comments up to date** with code changes
+- **Focus on intent** rather than implementation details
+
+### Error Handling
+- **Use specific exception types** rather than generic `Exception`
+- **Follow the "easier to ask for forgiveness than permission" (EAFP) principle**
+- **Handle errors at the appropriate level** - don't catch exceptions you can't handle meaningfully
+
+### Performance and Optimization
+- **Write clear code first** - optimize only when necessary and after measurement
+- **Use appropriate data structures** for the task
+- **Leverage built-in functions** and library functions when they're clearer
+- **Profile before optimizing** - don't guess where bottlenecks are
+
+## Code Review Checklist
+
+When generating or reviewing Python code, ensure:
+- [ ] The simplest solution that works is chosen
+- [ ] Names clearly communicate purpose
+- [ ] Code is easily scannable and readable
+- [ ] Pythonic patterns are used appropriately
+- [ ] No unnecessary duplication exists
+- [ ] Conventions are followed consistently
+- [ ] Comments explain intent where needed
+- [ ] Error handling is appropriate
+- [ ] The code would be easy for another developer to understand and maintain
+
+## Decision Framework
+
+When faced with coding choices, ask:
+1. **Is this the simplest solution that works?**
+2. **Will this be clear to someone reading it in 6 months?**
+3. **Am I using Python idioms appropriately?**
+4. **Am I duplicating logic that could be abstracted?**
+5. **Does this follow our established conventions?**
+6. **Is this optimized for readability?**
+
+The answer to all these questions should be "yes" for beautiful Python code.

specs/score2.md

@@ -0,0 +1,135 @@
+# CVD Risk Prediction Formula
+
+## Overview
+
+This formula calculates the 10-year risk of cardiovascular disease (CVD) using a sex-specific Cox proportional hazards model. The model incorporates multiple risk factors with specific transformations and interaction terms to provide personalized risk estimates.
+
+**Target Population**: European patients aged 40-69 years without prior CVD or diabetes.
+
+## Model Coefficients and Baseline Survival
+
+The model coefficients and baseline survival to calculate 10-year risk of CVD are as follows:
+
+| Risk Factor | Transformation | Male | Female |
+|-------------|----------------|------|--------|
+| Age, years | cage = (age - 60)/5 | 0.3742 | 0.4648 |
+| Smoking | current = 1, other = 0 | 0.6012 | 0.7744 |
+| SBP, mm Hg | csbp = (sbp - 120)/20 | 0.2777 | 0.3131 |
+| Total cholesterol, mmol/L | ctchol = tchol - 6 | 0.1458 | 0.1002 |
+| HDL cholesterol, mmol/L | chdl = (hdl - 1.3)/0.5 | -0.2698 | -0.2606 |
+| Smoking*age interaction | smoking*cage | -0.0755 | -0.1088 |
+| SBP*age interaction | csbp*cage | -0.0255 | -0.0277 |
+| Total cholesterol*age interaction | ctchol*cage | -0.0281 | -0.0226 |
+| HDL cholesterol*age interaction | chdl*cage | 0.0426 | 0.0613 |
+| **Baseline survival** | | **0.9605** | **0.9776** |
+
+## Risk Calculation Formula
+
+The uncalibrated 10-year risk of CVD is calculated by the following:
+
+**10-year risk = 1 - (baseline survival)^exp(x)**
+
+where **x = Σ[β*(transformed variables)]**
+
+## Regional Calibration
+
+The region and sex-specific scales to calculate calibrated 10-year risk are as follows:
+
+| Risk Region | Male Scale 1 | Male Scale 2 | Female Scale 1 | Female Scale 2 |
+|-------------|--------------|--------------|----------------|----------------|
+| Low | -0.5699 | 0.7476 | -0.7380 | 0.7019 |
+| Moderate | -0.1565 | 0.8009 | -0.3143 | 0.7701 |
+| High | 0.3207 | 0.9360 | 0.5710 | 0.9369 |
+| Very high | 0.5836 | 0.8294 | 0.9412 | 0.8329 |
+
+### Calibrated Risk Calculation Formula
+
+The calibrated 10-year risk of CVD is calculated by the following:
+
+**Calibrated 10-year risk, % = [1 - exp(-exp(scale1 + scale2*ln(-ln(1 - 10-year risk))))] * 100**
+
+### Regional Risk Classification
+
+- **Belgium**: Classified as a **Low Risk** region
+- For initial development, use the Low Risk calibration scales:
+  - Males: Scale 1 = -0.5699, Scale 2 = 0.7476
+  - Females: Scale 1 = -0.7380, Scale 2 = 0.7019
+
+## Model Components Explained
+
+### Risk Factor Transformations
+
+1. **Age (cage)**: Centered at 60 years and scaled by 5-year intervals
+   - `cage = (age - 60)/5`
+
+2. **Smoking**: Binary indicator
+   - `current = 1, other = 0`
+
+3. **Systolic Blood Pressure (csbp)**: Centered at 120 mmHg and scaled by 20 mmHg intervals
+   - `csbp = (sbp - 120)/20`
+
+4. **Total Cholesterol (ctchol)**: Centered at 6 mmol/L
+   - `ctchol = tchol - 6`
+
+5. **HDL Cholesterol (chdl)**: Centered at 1.3 mmol/L and scaled by 0.5 mmol/L intervals
+   - `chdl = (hdl - 1.3)/0.5`
+
+### Interaction Terms
+
+The model includes four age interaction terms that capture how the effect of risk factors changes with age:
+
+1. **Smoking × Age**: `smoking × cage`
+2. **SBP × Age**: `csbp × cage`
+3. **Total Cholesterol × Age**: `ctchol × cage`
+4. **HDL Cholesterol × Age**: `chdl × cage`
+
+### Sex-Specific Differences
+
+- **Females** generally have higher baseline survival (0.9776 vs 0.9605)
+- **Smoking** has a stronger effect in females (0.7744 vs 0.6012)
+- **Age** has a stronger effect in females (0.4648 vs 0.3742)
+- **SBP** has a slightly stronger effect in females (0.3131 vs 0.2777)
+- **HDL cholesterol** protective effect is similar between sexes
+
+## Implementation Workflow
+
+1. **Calculate uncalibrated risk** using the base formula with model coefficients
+2. **Apply regional calibration** using the appropriate scales for the patient's location and sex
+3. **Output calibrated percentage** as the final 10-year CVD risk estimate
+
+## Implementation Notes
+
+1. **Input Units**:
+   - Age: years
+   - SBP: mmHg
+   - Total cholesterol: mmol/L
+   - HDL cholesterol: mmol/L
+   - Smoking: binary (1 = current smoker, 0 = other)
+
+2. **Output**: 10-year CVD risk as a percentage (0-100%)
+
+3. **Model Type**: Cox proportional hazards model with sex-specific coefficients and regional calibration
+
+4. **Default Region**: Belgium (Low Risk region) for initial application development
+
+## Risk Stratification
+
+### Age-Specific Risk Categories
+
+#### Patients <50 years old
+
+- Low to moderate risk: <2.5%
+- High risk: 2.5% to <7.5%
+- Very high risk: ≥7.5%
+
+#### Patients 50-69 years old
+
+- Low to moderate risk: <5%
+- High risk: 5% to <10%
+- Very high risk: ≥10%
+
+### Treatment Recommendations
+
+- **Low to moderate risk**: Risk factor treatment plan generally not recommended.
+- **High risk**: Risk factor treatment plan should be considered (i.e., blood pressure and LDL-C control).
+- **Very high risk**: Risk factor treatment plan should be recommended (i.e., blood pressure and LDL-C control).