Marco Canepa1, Candida Fonseca2, Ovidiu Chioncel3, Cécile Laroche4, Maria G Crespo-Leiro5, Andrew J S Coats6, Alexandre Mebazaa7, Massimo F Piepoli8, Luigi Tavazzi9, Aldo P Maggioni10. 1. Cardiology Unit, Department of Internal Medicine, University of Genova, and Ospedale Policlinico San Martino IRCCS, Genova, Italy. 2. Heart Failure Management Programme, S. Francisco Xavier Hospital, CHLO. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal. 3. University of Medicine Carol Davila, Bucuresti, Romania, and the Institutul de Urgente Boli Cardiovasculare C.C. Iliescu, Bucuresti, Romania. 4. EURObservational Research Programme (EORP), European Society of Cardiology, Sophia Antipolis, France. 5. Heart Failure and Heart Transplant Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, INIBIC, La Coruña, Spain. 6. San Raffaele Pisana Scientific Institute, Rome, Italy. 7. University Paris 7; Assistance Publique-Hôpitaux de Paris, U942 Inserm, Paris, France. 8. Heart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Italy. 9. Maria Cecilia Hospital, GVM Care&Research-ES Health Science Foundation, Cotignola, Italy. 10. EURObservational Research Programme (EORP), European Society of Cardiology, Sophia Antipolis, France; ANMCO Research Center, Florence, Italy. Electronic address: amaggioni@escardio.org.
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.
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.
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