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Prognostic Models for Mortality and Morbidity in Heart Failure With Preserved Ejection Fraction.
McDowell, Kirsty; Kondo, Toru; Talebi, Atefeh; Teh, Ken; Bachus, Erasmus; de Boer, Rudolf A; Campbell, Ross T; Claggett, Brian; Desai, Ashkay S; Docherty, Kieran F; Hernandez, Adrian F; Inzucchi, Silvio E; Kosiborod, Mikhail N; Lam, Carolyn S P; Martinez, Felipe; Simpson, Joanne; Vaduganathan, Muthiah; Jhund, Pardeep S; Solomon, Scott D; McMurray, John J V.
Afiliación
  • McDowell K; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Kondo T; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Talebi A; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
  • Teh K; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Bachus E; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • de Boer RA; Department of Clinical Science, Lunds University Faculty of Medicine, Malmoe, Sweden.
  • Campbell RT; Erasmus Medical Centre, Department of Cardiology, Rotterdam, the Netherlands.
  • Claggett B; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Desai AS; Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
  • Docherty KF; Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
  • Hernandez AF; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Inzucchi SE; Duke University Medical Center, Durham, North Carolina.
  • Kosiborod MN; Section of Endocrinology, Yale University School of Medicine, New Haven, Connecticut.
  • Lam CSP; Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City.
  • Martinez F; National Heart Centre Singapore, Singapore.
  • Simpson J; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore.
  • Vaduganathan M; Instituto DAMIC, Cordoba National University, Cordoba, Argentina.
  • Jhund PS; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
  • Solomon SD; Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts.
  • McMurray JJV; British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
JAMA Cardiol ; 9(5): 457-465, 2024 May 01.
Article en En | MEDLINE | ID: mdl-38536153
ABSTRACT
Importance Accurate risk prediction of morbidity and mortality in patients with heart failure with preserved ejection fraction (HFpEF) may help clinicians risk stratify and inform care decisions.

Objective:

To develop and validate a novel prediction model for clinical outcomes in patients with HFpEF using routinely collected variables and to compare it with a biomarker-driven approach. Design, Setting, and

Participants:

Data were used from the Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure (DELIVER) trial to derive the prediction model, and data from the Angiotensin Receptor Neprilysin Inhibition in Heart Failure With Preserved Ejection Fraction (PARAGON-HF) and the Irbesartan in Heart Failure With Preserved Ejection Fraction Study (I-PRESERVE) trials were used to validate it. The outcomes were the composite of HF hospitalization (HFH) or cardiovascular death, cardiovascular death, and all-cause death. A total of 30 baseline candidate variables were selected in a stepwise fashion using multivariable analyses to create the models. Data were analyzed from January 2023 to June 2023. Exposures Models to estimate the 1-year and 2-year risk of cardiovascular death or hospitalization for heart failure, cardiovascular death, and all-cause death.

Results:

Data from 6263 individuals in the DELIVER trial were used to derive the prediction model and data from 4796 individuals in the PARAGON-HF trial and 4128 individuals in the I-PRESERVE trial were used to validate it. The final prediction model for the composite outcome included 11 variables N-terminal pro-brain natriuretic peptide (NT-proBNP) level, HFH within the past 6 months, creatinine level, diabetes, geographic region, HF duration, treatment with a sodium-glucose cotransporter 2 inhibitor, chronic obstructive pulmonary disease, transient ischemic attack/stroke, any previous HFH, and heart rate. This model showed good discrimination (C statistic at 1 year, 0.73; 95% CI, 0.71-0.75) in both validation cohorts (C statistic at 1 year, 0.71; 95% CI, 0.69-0.74 in PARAGON-HF and 0.75; 95% CI, 0.73-0.78 in I-PRESERVE) and calibration. The model showed similar discrimination to a biomarker-driven model including high-sensitivity cardiac troponin T and significantly better discrimination than the Meta-Analysis Global Group in Chronic (MAGGIC) risk score (C statistic at 1 year, 0.60; 95% CI, 0.58-0.63; delta C statistic, 0.13; 95% CI, 0.10-0.15; P < .001) and NT-proBNP level alone (C statistic at 1 year, 0.66; 95% CI, 0.64-0.68; delta C statistic, 0.07; 95% CI, 0.05-0.08; P < .001). Models derived for the prediction of all-cause and cardiovascular death also performed well. An online calculator was created to allow calculation of an individual's risk. Conclusions and Relevance In this prognostic study, a robust prediction model for clinical outcomes in HFpEF was developed and validated using routinely collected variables. The model performed better than NT-proBNP level alone. The model may help clinicians to identify high-risk patients and guide treatment decisions in HFpEF.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Causas de Muerte / Insuficiencia Cardíaca Diastólica / Modelos Cardiovasculares Límite: Humans / Male Idioma: En Revista: JAMA Cardiol Año: 2024 Tipo del documento: Article País de afiliación: Reino Unido

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Causas de Muerte / Insuficiencia Cardíaca Diastólica / Modelos Cardiovasculares Límite: Humans / Male Idioma: En Revista: JAMA Cardiol Año: 2024 Tipo del documento: Article País de afiliación: Reino Unido