Author + information
- Antoni Bayés-Genís, MD, PhD∗ ( and )
- Josep Lupón, MD, PhD
- ↵∗Heart Institute, Hospital Universitari Germans Trias i Pujol, Department of Medicine, Universitat Autònoma de Barcelona, Carretera de Canyet s/n 08916, Badalona (Barcelona), Spain
We read with interest the study by Canepa et al. (1) on prognostic risk scores in chronic heart failure (HF). The authors are to be commended for using contemporary registry data to assess 1- and 2-year all-cause mortality risk using 4 reported risk scores: CHARM (Candesartan in Heart Failure-Assessment of Reduction Mortality), GISSI-HF (Grupo 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). Unsurprisingly, the performance of these scores was poor, ranging from an area under the curve (AUC) of 0.743 for MAGGIC to 0.714 for SHFM (1).
The management of HF has evolved rapidly in recent years, and well into the 21st century, these scores have several limitations that limit their use. First, they were developed and validated in patients enrolled more than 20 years ago. Second, they did not include real-life data but only select patients who fulfilled clinical trial inclusion and exclusion criteria. Third, none of the scores incorporate biomarkers. The Barcelona Bio-HF Calculator (2) is a contemporary web-based HF risk score derived from a well-characterized and managed, contemporary, real-world cohort (3) and validated in a well-acknowledged contemporary clinical trial, the PARADIGM-HF (Efficacy and Safety of LCZ696 Compared to Enalapril on Morbidity and Mortality of Patients With Chronic Heart Failure) trial (4). The Barcelona Bio-HF Calculator has 3 columns (Figure 1). The left column includes conventional clinical data (age, sex, left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, duration of the disease, and prior hospitalizations) and important comorbidities, such as anemia, renal dysfunction, and diabetes. The center column reports up-to-date treatment data, including diuretics, beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoid receptor antagonists, angiotensin receptor neprilysin inhibitor, and devices (cardiac resynchronization therapy and implantable cardioverter-defibrillator). The right column incorporates state-of-the-art biomarkers, such as N-terminal pro–B-type natriuretic peptide (surrogate for myocardial strain), high-sensitivity troponin T (surrogate for myocyte damage), and ST2 (reflective of inflammation and extracellular matrix remodeling). The calculator runs with the use of none, 1, 2, or 3 biomarkers, assuming that not all clinicians may have access to all 3. The calculator provides the risk for all-cause death, the risk for HF hospitalization (using competitive risks assessment), and the composite of death and hospitalization, all of them yearly up to 5 years. The AUCs of the BCN Bio-HF Calculator for all-cause death, HF hospitalization, and the composite of both at 2 years were 0.83, 0.79, and 0.80, respectively (0.80, 0.79, and 0.77, respectively without use of biomarkers) (2), substantially higher than those reported by Canepa et al. (1).
We encourage investigators and clinicians to use the Barcelona Bio-HF Calculator as it collates in a user-friendly manner the most contemporary clinical, treatment, and biological predictors of HF. Eventually, real-life patients of the long-term HF registry of the European Society of Cardiology may also be tested in the calculator.
Please note: Drs. Bayés-Genís and Lupón are stock owners with Critical Care Diagnostics; and have received lecture honoraria from Roche Diagnostics.
- 2018 American College of Cardiology Foundation
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