Author + information
- Received November 6, 2017
- Revision received January 29, 2018
- Accepted February 6, 2018
- Published online May 28, 2018.
- Marco Canepa, MD, PhDa,
- Candida Fonseca, MD, PhDb,
- Ovidiu Chioncel, MDc,
- Cécile Laroche, MSd,
- Maria G. Crespo-Leiro, MD, PhDe,
- Andrew J.S. Coats, MD, PhDf,
- Alexandre Mebazaa, MD, PhDg,
- Massimo F. Piepoli, MD, PhDh,
- Luigi Tavazzi, MD, PhDi,
- Aldo P. Maggioni, MDd,j,∗ ( )(, )
- on behalf of the ESC HF Long Term Registry Investigators
- aCardiology Unit, Department of Internal Medicine, University of Genova, and Ospedale Policlinico San Martino IRCCS, Genova, Italy
- bHeart Failure Management Programme, S. Francisco Xavier Hospital, CHLO. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
- cUniversity of Medicine Carol Davila, Bucuresti, Romania, and the Institutul de Urgente Boli Cardiovasculare C.C. Iliescu, Bucuresti, Romania
- dEURObservational Research Programme (EORP), European Society of Cardiology, Sophia Antipolis, France
- eHeart Failure and Heart Transplant Unit, Complexo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, INIBIC, La Coruña, Spain
- fSan Raffaele Pisana Scientific Institute, Rome, Italy
- gUniversity Paris 7; Assistance Publique-Hôpitaux de Paris, U942 Inserm, Paris, France
- hHeart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Italy
- iMaria Cecilia Hospital, GVM Care&Research–ES Health Science Foundation, Cotignola, Italy
- jANMCO Research Center, Florence, Italy
- ↵∗Address for correspondence:
Dr. Aldo P. Maggioni, ANMCO Research Center, Via La Marmora, 34, 50121 Firenze, Italy.
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.
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.
- Received November 6, 2017.
- Revision received January 29, 2018.
- Accepted February 6, 2018.
- 2018 American College of Cardiology Foundation