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Article pour les cliniciens

Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies.



  • Pocock SJ
  • Ariti CA
  • McMurray JJ
  • Maggioni A
  • Kober L
  • Squire IB, et al.
Eur Heart J. 2013 May;34(19):1404-13. doi: 10.1093/eurheartj/ehs337. Epub 2012 Oct 24. (Original)
PMID: 23095984
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Disciplines
  • Médecine interne (voir sous-spécialités ci-dessous)
    Relevance - 6/7
    Intérêt médiatique  - 6/7
  • - Cardiologie
    Relevance - 5/7
    Intérêt médiatique  - 5/7

Résumé (en anglais)

AIMS: Using a large international database from multiple cohort studies, the aim is to create a generalizable easily used risk score for mortality in patients with heart failure (HF).

METHODS AND RESULTS: The MAGGIC meta-analysis includes individual data on 39 372 patients with HF, both reduced and preserved left-ventricular ejection fraction (EF), from 30 cohort studies, six of which were clinical trials. 40.2% of patients died during a median follow-up of 2.5 years. Using multivariable piecewise Poisson regression methods with stepwise variable selection, a final model included 13 highly significant independent predictors of mortality in the following order of predictive strength: age, lower EF, NYHA class, serum creatinine, diabetes, not prescribed beta-blocker, lower systolic BP, lower body mass, time since diagnosis, current smoker, chronic obstructive pulmonary disease, male gender, and not prescribed ACE-inhibitor or angiotensin-receptor blockers. In preserved EF, age was more predictive and systolic BP was less predictive of mortality than in reduced EF. Conversion into an easy-to-use integer risk score identified a very marked gradient in risk, with 3-year mortality rates of 10 and 70% in the bottom quintile and top decile of risk, respectively.

CONCLUSION: In patients with HF of both reduced and preserved EF, the influences of readily available predictors of mortality can be quantified in an integer score accessible by an easy-to-use website www.heartfailurerisk.org. The score has the potential for widespread implementation in a clinical setting.


Commentaires cliniques (en anglais)

Cardiology

Interesting compliation of CHF risks.

Internal Medicine

Useful information. I found the list of determinants and their order of importance valuable. Having to go to a website and input data would be an impediment to practical use right now.

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