Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies

Pocock, Stuart J.; Ariti, Cono; McMurray, John J.V.; Maggioni, Aldo P.; Køber, Lars; Squire, Iain B.; Swedberg, Karl; Dobson, Joanna; Poppe, Katrina; Whalley, Gillian A.; Doughty, Rob

doi:10.1093/eurheartj/ehs337

Cited by 978 publications

(873 citation statements)

References 20 publications

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“…We found that despite different inclusion/exclusion criteria for the 2 studies, patients enrolled in the PARADIGM‐HF trial had similar baseline characteristics to those enrolled in the CHAMP‐HF registry. They also had similar projected risk of all‐cause mortality, as assessed by the MAGGIC risk score, where a score of 20 (PARADIGM‐HF) is associated with a 1‐year risk of death of 10.2% and a score of 22 (CHAMP‐HF) is associated with a 1‐year risk of death of 12.2% 7. These findings suggest that the population of patients with HFrEF enrolled in the PARADIGM‐HF trial largely reflects patients with HFrEF encountered in outpatient clinical practice.…”

Section: Discussionmentioning

confidence: 85%

“…The Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for mortality in HF was reported as a median with an interquartile range 7. Variables required for calculation of the MAGGIC risk score include age, sex, body mass index, current smoker, SBP, diabetes mellitus, NYHA class, LVEF, chronic obstructive pulmonary disease, HF duration, serum creatinine, and medication use.…”

Section: Methodsmentioning

confidence: 99%

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Characteristics and Treatments of Patients Enrolled in the CHAMP‐HF Registry Compared With Patients Enrolled in the PARADIGM‐HF Trial

DeVore

Thomas

et al. 2018

JAHA

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BackgroundThe US Food and Drug Administration approved sacubitril/valsartan for patients with chronic heart failure (HF) with reduced ejection fraction in 2015 on the basis of the results of the PARADIGM‐HF (Prospective Comparison of ARNI [Angiotensin Receptor Neprilysin Inhibitor] With ACEI [Angiotensin‐Converting Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial. There are limited data assessing the generalizability of PARADIGM‐HF trial participants to a broader population of patients with HF with reduced ejection fraction routinely encountered in outpatient clinical practice.Methods and ResultsWe compared the baseline characteristics of patients in the PARADIGM‐HF trial with those in the CHAMP‐HF (Change the Management of Patients With Heart Failure) study a large US outpatient registry of patients with HF with reduced ejection fraction. Patients in the PARADIGM‐HF trial (n=8442) were similar to those in the CHAMP‐HF registry (n=3497) in terms of age (mean, 64 versus 66 years), sex (22% versus 29% women), New York Heart Association class III to IV (25% versus 32%), systolic blood pressure (mean, 121 versus 121 mm Hg), left ventricular ejection fraction (mean, 29% versus 29%), and other key baseline characteristics. The median (25th–75th percentile) Meta‐Analysis Global Group in Chronic Heart Failure risk scores were similar for the 2 studies (20 [16–24] versus 22 [8–27]). Despite this, only 13% of patients in the CHAMP‐HF registry were prescribed sacubitril/valsartan at baseline.ConclusionsThese data suggest participants randomized in the PARADIGM‐HF trial have similar baseline characteristics to those encountered in routine outpatient clinical practice, but there is a substantial lag in the adoption of sacubitril/valsartan for patients with chronic HF with reduced ejection fraction.

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Section: Discussionmentioning

confidence: 85%

Section: Methodsmentioning

confidence: 99%

Characteristics and Treatments of Patients Enrolled in the CHAMP‐HF Registry Compared With Patients Enrolled in the PARADIGM‐HF Trial

DeVore

Thomas

et al. 2018

JAHA

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“…8 This is the generalizable easily used integer risk score for mortality in patients with heart failure, including 13 independent predictors: age, LVEF, New York Heart Association (NYHA) class, serum creatinine, diabetes mellitus, β‐blocker, systolic blood pressure, body mass index, time since diagnosis, current smoker, chronic obstructive pulmonary disease, male gender, and ACE inhibitor or ARB.…”

Section: Methodsmentioning

confidence: 99%

“…Event‐free survival curves were constructed using the Kaplan–Meier method, and the statistical significance of differences between curves was assessed using the log‐rank test. Cox proportional hazard analysis was performed with 22 clinical variables that are generally recognized parameters influencing heart failure prognosis [age, body mass index, current smoker, NYHA class III or IV, duration of heart failure, heart rate, systolic blood pressure, diabetes mellitus, implantable cardioverter defibrillator (ICD) or biventricular ICD, logBNP, haemoglobin, estimated glomerular filtration rate, β‐blocker at discharge, ACE inhibitor or ARB at discharge, aldosterone inhibitor at discharge, loop diuretic at discharge, LVEDDI, LVEF, mitral regurgitation, restrictive filling pattern, heart failure risk score, fibrosis area] and TNC area, and variables achieving P < 0.05 on univariable analysis were then tested in multivariable Cox analysis to determine which ones were significantly associated with death 8. Univariable linear regression analysis for TNC area was performed using all variables in the baseline characteristics, and then multivariable linear regression analysis was performed using the variables achieving P < 0.05 on univariable linear regression analysis to determine the factors associated with TNC area.…”

Section: Methodsmentioning

confidence: 99%

Significance of myocardial tenascin‐C expression in left ventricular remodelling and long‐term outcome in patients with dilated cardiomyopathy

Yokokawa

Sugano

Nakayama

et al. 2016

European J of Heart Fail

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AimDilated cardiomyopathy (DCM) has a variety of causes, and no useful approach to predict left ventricular (LV) remodelling and long‐term outcome has yet been established. Myocardial tenascin‐C (TNC) is known to appear under pathological conditions, possibly to regulate cardiac remodelling. The aim of this study was to clarify the significance of myocardial TNC expression in LV remodelling and the long‐term outcome in DCM.Methods and resultsOne hundred and twenty‐three consecutive DCM patients who underwent endomyocardial biopsy for initial diagnosis were studied. Expression of TNC in biopsy sections was analysed immunohistochemically to quantify the ratio of the TNC‐positive area to the whole myocardial tissue area (TNC area). Clinical parameters associated with TNC area were investigated. The patients were divided into two groups based on receiver operating characteristic analysis of TNC area to predict death: high TNC group with TNC area ≥2.3% (22 patients) and low TNC group with TNC area <2.3% (101 patients). High TNC was associated with diabetes mellitus. Comparing echocardiographic findings between before and 9 months after endomyocardial biopsy, the low TNC group was associated with decreased LV end‐diastolic diameter and increased LV ejection fraction, whereas the high TNC group was not. Survival analysis revealed a worse outcome in the high TNC group than in the low TNC group (P < 0.001). Multivariable Cox regression analysis revealed that TNC area was independently associated with poor outcome (HR = 1.347, P = 0.032).ConclusionsIncreased myocardial TNC expression was associated with worse LV remodeling and long‐term outcome in DCM.

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“…Recently, several risk stratification scores using various parameters have been reported for the prediction of all‐cause mortality, sudden cardiac death, and cardiovascular events in patients with HF 9, 10, 11, 12, 13, 14, 15, 16. For example, the AHEAD (atrial fibrillation, hemoglobin, elderly, abnormal renal parameters, diabetes mellitus) score was established for long‐term risk prediction in acute HF 15.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of Get With the Guidelines–Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization

Suzuki

Yoshihisa

Sato

et al. 2018

JAHA

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BackgroundThe Get With the Guidelines–Heart Failure (GWTG‐HF) risk score was developed using American Heart Association GWTG‐HF program data and predicts in‐hospital mortality in patients with acute heart failure (HF). We aimed to clarify the prognostic impacts of the GWTG‐HF risk score in patients with HF after discharge.Methods and ResultsWe examined the GWTG‐HF score in 1452 patients with HF, who were admitted to our hospital and discharged after treatment, by calculating 7 predetermined variables. We divided all subjects into 3 groups according to the GWTG‐HF risk score (low, moderate, and high score groups). The plasma B‐type natriuretic peptide level significantly increased with increasing GWTG‐HF risk score severity (median values of B‐type natriuretic peptide: 167.0 in low, 260.7 in moderate, and 418.2 pg/mL in high score groups). We followed up all subjects after discharge, and there were 347 (23.9%) all‐cause deaths and 407 (28.0%) cardiac events in follow‐up periods. A Kaplan‐Meier survival curve demonstrated that event rates of all‐cause death and cardiovascular events, including worsening HF and cardiac death, significantly increased with increasing GWTG‐HF risk score severity in all subjects, and also in 749 patients with HF with preserved ejection fraction (ejection fraction ≥50%) and 703 patients with HF with reduced ejection fraction (ejection fraction <50%) patients. The multivariable Cox proportional hazard regression analysis demonstrated that the GWTG‐HF risk score was one of the significant predictors of all‐cause mortality and cardiac events (all‐cause mortality: hazard ratio, 1.537, 95% confidence interval, 1.172–2.023; cardiac events: hazard ratio, 1.584, 95% confidence interval, 1.344–1.860, per 10‐point increase of GWTG‐HF score).ConclusionsThe GWTG‐HF risk score is a useful multivariable score model for several years after hospitalization in patients with HF in a Japanese population.

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Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies

Cited by 978 publications

References 20 publications

Characteristics and Treatments of Patients Enrolled in the CHAMP‐HF Registry Compared With Patients Enrolled in the PARADIGM‐HF Trial

Characteristics and Treatments of Patients Enrolled in the CHAMP‐HF Registry Compared With Patients Enrolled in the PARADIGM‐HF Trial

Significance of myocardial tenascin‐C expression in left ventricular remodelling and long‐term outcome in patients with dilated cardiomyopathy

Clinical Significance of Get With the Guidelines–Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization

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