Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: the LIFE-HF model

Burger, P. M. et al. (2023) Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction: the LIFE-HF model. European Journal of Heart Failure, (doi: 10.1002/ejhf.3028) (Early Online Publication)

Abstract

Aims Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. Methods and results Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65–0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium–glucose cotransporter 2 inhibitor, and angiotensin receptor–neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7–3.7) and 3.7 (IQR 2.4–5.5) additional years of overall and HF hospitalization-free survival, respectively. Conclusion The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.

• Item Type: Articles
• Additional Information: This study was funded by an unrestricted educational grant from Novartis, received by the Department of Vascular Medicine of the University Medical Centre Utrecht.
• Status: Early Online Publication
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Adamson, Dr Carly and Jhund, Professor Pardeep and McMurray, Professor John
• Authors: Burger, P. M., Savarese, G., Tromp, J., Adamson, C., Jhund, P. S., Benson, L., Hage, C., Tay, W. T., Solomon, S. D., Packer, M., Rossello, X., McEvoy, J. W., De Bacquer, D., Timmis, A., Vardas, P., Graham, I. M., Di Angelantonio, E., Visseren, F. L.J., McMurray, J. J.V., Lam, C. S.P., Lund, L. H., Koudstaal, S., Dorresteijn, J. A.N., Mosterd, A., and European Society of Cardiology’s Cardiovascular Risk Collab.,
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 10 September 2023
• Copyright Holders: Copyright: © 2023 European Society of Cardiology
• First Published: First published in European Journal of Heart Failure 2023
• Publisher Policy: Reproduced in accordance with the publisher copyright policy