Prognostic models derived in PARADIGM-HF and validated in ATMOSPHERE and the Swedish Heart Failure Registry to predict mortality and morbidity in chronic heart failure

Simpson, J. et al. (2020) Prognostic models derived in PARADIGM-HF and validated in ATMOSPHERE and the Swedish Heart Failure Registry to predict mortality and morbidity in chronic heart failure. JAMA Cardiology, 5(4), pp. 432-441. (doi: 10.1001/jamacardio.2019.5850) (PMID:31995119)

Abstract

Importance: Accurate prediction of risk of death or hospitalizations in patients with heart failure (HF) may allow physicians to explore how more accurate decisions regarding appropriateness and timing of disease modifying treatments, advanced therapies, or the need for end-of-life care can be made. Objective: To develop and validate a prognostic model for patients with HF. Design: Multivariable analyses were performed in a stepwise fashion. Harrell’s C-statistic was used to assess the discriminative ability. Setting: The derivation cohort was PARADIGM-HF participants. The models were validated using the ATMOSPHERE trial and the SwedeHF Registry. Participants: 8399 participants enrolled in PARADIGM-HF. Main Outcomes and Measures: Cardiovascular death, all-cause mortality and the composite of cardiovascular death or HF hospitalization, at both one and two years. Results: Complete baseline clinical data were available for 8011 patients in PARADIGM-HF. During a mean follow up of 27 months 1546 patients died and 2031 had a CV death or HF hospitalization. The common variables were: male sex, race (Black or Asian), region (Central Europe or Latin America), HF duration of over 5 years, NYHA class III/ IV, LVEF, diabetes mellitus, beta-blocker use at baseline and allocation to sacubitril/valsartan. Ranked by chi-square, NTproBNP was the single most powerful independent predictor of each outcome. The C-statistic at 1 and 2 years was 0.74 (95% CI 0.71-0.76) and 0.71 (0.70-0.73) for the primary composite endpoint, 0.73 (0.71-0.75) and 0.71 (0.69-0.73) for CV death, and 0.71 (0.69-0.74) and 0.70 (0.67-0.74) for all-cause death, respectively. When validated in ATMOSPHERE, the C statistic at 1 and 2 years was 0.71 (0.69-0.72) and 0.70 (0.68-0.71) for the primary composite end point, 0.71 (0.69-0.74) and 0.70 (0.69-0.72) for CV death, and 0.71 (0.69-0.74) and 0.70 (0.68-0.72) for all-cause death, respectively. An on-line calculator was created to allow calculation of an individual’s risk (http://www.predict-hf.com). Conclusions and Relevance: Predictive models performed well and were developed and externally validated in large cohorts of geographically representative patients, comprehensively characterized with clinical and laboratory data, including natriuretic peptides, and who were receiving contemporary evidence-based treatment.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Simpson, Dr Joanne and Jhund, Professor Pardeep and Shen, Dr Li and Petrie, Professor Mark and McMurray, Professor John and Padmanabhan, Professor Sandosh and Kober, Professor Lars
• Authors: Simpson, J., Jhund, P. S., Lund, L. H., Padmanabhan, S., Clagget, B. L., Shen, L., Petrie, M. C., Abraham, W. T., Desai, A. S., Dickstein, K., Kober, L., Paker, M., Rouleau, J. L., Mueller-Velten, G., Solomon, S. D., Swedberg, K., Zile, M. R., and McMurray, J. J.V.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JAMA Cardiology
• Publisher: American Medical Association
• ISSN: 2380-6583
• ISSN (Online): 2380-6591
• Published Online: 29 January 2020