Elsevier

JACC: Heart Failure

Volume 6, Issue 6, June 2018, Pages 452-462
JACC: Heart Failure

Mini-Focus Issue: Risk Factors and Outcomes in Chronic Heart Failure
Clinical Research
Performance of Prognostic Risk Scores in Chronic Heart Failure Patients Enrolled in the European Society of Cardiology Heart Failure Long-Term Registry

https://doi.org/10.1016/j.jchf.2018.02.001Get rights and content
Under an Elsevier user license
open archive

Abstract

Objectives

This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry.

Background

Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited.

Methods

This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final sample of 6,161 patients.

Results

At 1-year follow-up, 5,653 of 6,161 patients (91.8%) were alive. The observed-to-predicted survival ratios (CHARM: 1.10, GISSI-HF: 1.08, MAGGIC: 1.03, and SHFM: 0.98) suggested some overestimation of mortality by all scores except the SHFM. Overprediction occurred steadily across levels of risk using both the CHARM and the GISSI-HF, whereas the SHFM underpredicted mortality in all risk groups except the highest. The MAGGIC showed the best overall accuracy (area under the curve [AUC] = 0.743), similar to the GISSI-HF (AUC = 0.739; p = 0.419) but better than the CHARM (AUC = 0.729; p = 0.068) and particularly better than the SHFM (AUC = 0.714; p = 0.018). Less than 1% of patients received a prognostic estimate from their enrolling physician.

Conclusions

Performance of prognostic risk scores is still limited and physicians are reluctant to use them in daily practice. The need for contemporary, more precise prognostic tools should be considered.

Key Words

heart failure
mortality
prognosis
risk score

Abbreviations and Acronyms

AUC
area under the curve
HF
heart failure
ICD
implantable cardioverter-defibrillator
LVEF
left ventricular ejection fraction
SHFM
Seattle Heart Failure Model

Cited by (0)

Since the start of the EORP (EURObservational Research Programme), the following companies have supported the programme: Abbott Vascular Int. (2011–2014), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2017), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol-Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2017), Menarini Int. Op. (2009–2012), MSD–Merck & Co. (2011–2014), Novartis Pharma AG (2014–2017), ResMed (2014–2016), Sanofi (2009–2011), and Servier (2009–2018).

Dr. Chioncel has been on the steering committee for Novartis; and has received research grants from Servier, Vifor, and Novartis. Dr. Crespo-Leiro has received research funds and speaker fees and been on the advisory boards for Novartis, Amgen, Pfizer, and Abbott. Dr. Tavazzi has received personal fees from Servier and CVIE Therapeutics. Dr. Maggioni is a member of the study committees for Novartis and Bayer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.