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Canadian Journal of Cardiology

Performance of Prognostic Risk Scores in Heart Failure Patients: Do Sex Differences Exist?

Published:August 22, 2019DOI:https://doi.org/10.1016/j.cjca.2019.08.021

      Abstract

      Background

      Sex differences in the performance of prognostic risk scores in heart failure (HF) patients have not previously been investigated. We examined the performance of 2 commonly used scores in predicting mortality and a composite end point consisting of ventricular assist device, heart transplantation, or mortality in women vs men with HF.

      Methods

      This was a retrospective study of 1,136 (25% women) consecutive ambulatory adult HF patients with reduced left ventricular ejection fraction (≤ 40%) followed at a single institution from 2000 to 2012. Discrimination, calibration, and absolute risk reclassification of the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score to predict 1- and 3-year outcomes were compared between women and men.

      Results

      At 1- and 3-year follow-ups, 116 (22% women) and 231 (21% women) patients died, respectively. Survival was equal between sexes (P = 0.41). The SHFM and the MAGGIC score showed similar discriminatory capacity in women (c-statistics 0.84, 95% CI 0.77-0.92, and 0.74, 95% CI 0.64-0.83) and men (c-statistics 0.74, 95% CI 0.69-0.79, and 0.70, 95% CI 0.64-0.75). There was no difference in the predicted and observed 1-year mortality by the scores in both sexes. Compared with the SHFM, the MAGGIC score better reclassified 10% (95% CI 7%-14%) of women and 18% (95% CI 15%-20%) of men. At 3-year follow-up, similar results were seen for discrimination, whereas both scores overestimated mortality with more marked overestimation in women. The results were reproducible for the composite end point, with improved calibration at 3-year follow-up in both scores.

      Conclusions

      Our findings support the use of the MAGGIC score in both women and men owing to better risk classification.

      Résumé

      Contexte

      Les différences entre les hommes et les femmes à l’égard de la fiabilité des scores de risque pronostiques chez les patients atteints d’insuffisance cardiaque (IC) n’ont pas encore été étudiées. Nous avons examiné le rendement de deux scores couramment utilisés pour prédire la mortalité ainsi qu’un critère d’évaluation composite regroupant l’implantation d’un dispositif d’assistance ventriculaire, une greffe cardiaque ou la mortalité chez les femmes et les hommes atteints d’IC.

      Méthodologie

      Il s’agissait d’une étude rétrospective portant sur 1136 patients adultes ambulatoires consécutifs atteints d’IC avec fraction d’éjection ventriculaire gauche réduite (≤ 40 %) suivis dans un même établissement de 2000 à 2012, dont 25 % étaient des femmes. La calibration ainsi que les propriétés de discrimination et de reclassification du risque absolu du modèle SHFM (Seattle Heart Failure Model) et du score MAGGIC (Meta-analysis Global Group in Chronic Heart Failure) pour prédire les résultats à 1 an et à 3 ans chez les femmes et les hommes ont été comparées.

      Résultats

      Au moment du suivi à 1 an et à 3 ans, 116 (22 % de femmes) et 231 (21 % de femmes) patients étaient décédés, respectivement. La survie était la même chez les hommes et chez les femmes (p = 0,41). Le modèle SHFM et le score MAGGIC avaient une puissance de discrimination comparable chez les femmes (statistique C de 0,84 [IC à 95 % : de 0,77 à 0,92]) et de 0,74 [IC à 95 % : de 0,64 à 0,83]) et chez les hommes (statistique C de 0,74 [IC à 95 % : de 0,69 à 0,79] et de 0,70 [IC à 95 % : de 0,64 à 0,75]). Aucune différence n’a été observée entre la mortalité à 1 an prédite par les scores et la mortalité réelle, quel que soit le sexe. Comparativement au modèle SHFM, le score MAGGIC a permis de mieux reclassifier 10 % (IC à 95 % : de 7 à 14 %) des femmes et 18 % (IC à 95 % : de 15 à 20 %) des hommes. Au moment du suivi à 3 ans, des résultats comparables ont été observés en matière de discrimination; les deux scores ont surestimé la mortalité, l’écart étant plus marqué chez les femmes. Les résultats étaient reproductibles pour ce qui est du critère d’évaluation composite, la calibration étant supérieure au suivi à 3 ans pour les deux scores.

      Conclusions

      Nos constatations appuient l’utilisation du score MAGGIC chez les femmes et les hommes, en raison de sa plus grande puissance de reclassification du risque.
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