TY - JOUR
T1 - Performance of Prognostic Risk Scores in Chronic Heart Failure Patients Enrolled in the European Society of Cardiology Heart Failure Long-Term Registry
AU - ESC HF Long Term Registry Investigators
AU - Canepa, Marco
AU - Fonseca, Candida
AU - Chioncel, Ovidiu
AU - Laroche, Cécile
AU - Crespo-Leiro, Maria G.
AU - Coats, Andrew J.S.
AU - Mebazaa, Alexandre
AU - Piepoli, Massimo F.
AU - Tavazzi, Luigi
AU - Maggioni, Aldo P.
AU - Anker, S.
AU - Filippatos, G.
AU - Ferrari, R.
AU - Amir, O.
AU - Dahlström, U.
AU - Delgado Jimenez, J. F.
AU - Drozdz, J.
AU - Erglis, A.
AU - Fazlibegovic, E.
AU - Fruhwald, F.
AU - Gatzov, P.
AU - Goncalvesova, E.
AU - Hassanein, M.
AU - Hradec, J.
AU - Kavoliuniene, A.
AU - Lainscak, M.
AU - Logeart, D.
AU - Merkely, B.
AU - Metra, M.
AU - Otljanska, M.
AU - Seferovic, P. M.
AU - Srbinovska Kostovska, E.
AU - Temizhan, A.
AU - Tousoulis, D.
AU - Ferreira, T.
AU - Andarala, M.
AU - Fiorucci, E.
AU - Folkesson Lefrancq, E.
AU - Glémot, M.
AU - Gracia, G.
AU - Konte, M.
AU - McNeill, P. A.
AU - Missiamenou, V.
AU - Taylor, C.
AU - Auer, J.
AU - Ablasser, K.
AU - Dolze, T.
AU - Brandner, K.
AU - Gstrein, S.
AU - Poelzl, G.
N1 - Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/6/1
Y1 - 2018/6/1
N2 - 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.
AB - 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.
KW - heart failure
KW - mortality
KW - prognosis
KW - risk score
UR - http://www.scopus.com/inward/record.url?scp=85047058709&partnerID=8YFLogxK
U2 - 10.1016/j.jchf.2018.02.001
DO - 10.1016/j.jchf.2018.02.001
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C2 - 29852929
AN - SCOPUS:85047058709
SN - 2213-1779
VL - 6
SP - 452
EP - 462
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 6
ER -