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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References
- Report on the health of Canadians. The burden of heart failure.(Available at:)http://www.heartandstroke.ca/-/media/pdf-files/canada/2017-heart-month/heartandstroke-reportonhealth-2016.ashx?la=enDate: 2016Date accessed: August 30, 2017
- Heart failure: preventing disease and death worldwide.ESC Heart Fail. 2014; 1: 4-25
- Heart disease and stroke statistics—2016 update: a report from the American Heart Association.Circulation. 2016; 133: e38-e360
- Who has advanced heart failure? Definition and epidemiology.Congest Heart Fail. 2011; 17: 160-168
- Risk prediction models for mortality in ambulatory patients with heart failure: a systematic review.Circ Heart Fail. 2013; 6: 881-889
- Predictors of mortality and morbidity in patients with chronic heart failure.Eur Heart J. 2006; 27: 65-75
- The Seattle heart failure model. Prediction of survival in heart failure.Circulation. 2006; 113: 1424-1433
- Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies.Eur Heart J. 2013; 34: 1404-1413
- Predicting survival in heart failure patients with implantable cardioverter-defibrillators: the Heart Failure Meta-score.J Card Fail. 2018; 24: 735-745
- 2017 Comprehensive update of the Canadian Cardiovascular Society Guidelines for the management of heart failure.Can J Cardiol. 2017; 33: 1342-1433
- Women, men and heart failure: a review.Heart Fail Monit. 2008; 6: 34-40
- Investigators of the Acute Decompensated Heart Failure Syndromes (ATTEND) Registry. Sex differences in left ventricular cavity dilation and outcomes in acute heart failure patients with left ventricular systolic dysfunction.Can J Cardiol. 2018; 34: 477-484
- Heart failure in women.Methodist Debakey Cardiovasc J. 2017; 13: 216-223
- Evaluation of the performance of survival analysis models: discrimination and calibration measures.in: Balakrishnan N. Rao C.R. Handbook of Statistics. Vol 23: Advances in Survival Analysis. Elsevier, 2004: 1-25
- Discrimination and calibration of clinical prediction models. User’s guides to the medical literature.JAMA. 2017; 318: 1377-1384
- Sex differences in in-hospital mortality in acute decompensated heart failure with reduced and preserved ejection fraction.Am Heart J. 2012; 163: 430-437
- Risk prediction in patients with heart failure. A systematic review and analysis.JACC Heart Fail. 2014; 2: 440-446
- Heart failure with reduced ejection fraction in women. Epidemiology, outcomes, and treatment.Heart Failure Clin. 2019; 15: 19-27
- Sex differences in clinical characteristics and long-term outcome in acute decompensated heat failure patients with preserved and reduced ejection fraction.Am J Physiol Heart Circ Physiol. 2016; 310: H813-H820
- The impact of gender difference on clinical and echocardiographic outcomes in patients with heart failure after cardiac resynchronization therapy: a systematic review and meta-analysis.PLoS One. 2017; 12e0176248
- Gender differences in cardiac resynchronization therapy device choice and outcome in patients ≥ 75 years of age with heart failure.Am J Cardiol. 2017; 120: 2201-2206
- Inequity in cardiovascular care in the English National Health Service (NHS): a scoping review of the literature.Health Soc Care Community. 2018; 26: 259-272
- Gender differences in continuous-flow left ventricular assist device therapy as a bridge to transplantation: a risk-adjusted comparison using a propensity score-matching analysis.Artif Organs. 2015; 39: 212-219
- Missing covariate data in medical research: to impute is better than to ignore.J Clin Epidemiol. 2010; 63: 721-727
Article info
Publication history
Published online: August 22, 2019
Accepted:
August 18,
2019
Received:
May 22,
2019
Footnotes
See editorial by Diamant and Toma, pages 11–12 of this issue.
See page 53 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Should We Be Using Sex-Specific Heart Failure Risk Scores?Canadian Journal of CardiologyVol. 36Issue 1
- PreviewWhen applied in the appropriate clinical setting, validated prognostic risk models provide a method to quantify and convey survival prospects to patients and care providers, and may help in decision making and directing care. Their use is endorsed by the most recent iteration of the Canadian Cardiovascular Society Heart Failure (HF) Guidelines.1 Although many risk scores have been published for patients in various stages of HF across multiple settings, the Seattle Heart Failure Model (SHFM)2 and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC)3 scores are two of the mostly widely used risk scores for ambulatory patients with HF.
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