March 15, 2019Annals of the Academy of Medicine Singapore17 citationsOpen Access

The Singapore Heart Failure Risk Score: Prediction of Survival in Southeast Asian Patients

JYJonathan YapNational Heart Centre Singapore SCShaw Yang ChiaNational Heart Centre Singapore FLFang Yi LimNational Heart Centre Singapore

Structured PICO

Does the Singapore Heart Failure Risk Score accurately predict 1- and 2-year survival in Southeast Asian patients hospitalized for heart failure?

Population

2,925 consecutive adults (≥21 years) hospitalized for heart failure (DRG code 252) in Singapore, comprising a derivation cohort (n=1,392) and two validation cohorts (n=729 and n=804). Mean age ranged from 68.2 to 71.4 years, 43.5% to 56.7% male. Excluded repeat admissions and foreigners.

Intervention

Singapore Heart Failure Risk Score (SHFRS), a 10-variable clinical risk prediction model (age, prior myocardial infarction, prior stroke, atrial fibrillation, peripheral vascular disease, systolic blood pressure, QRS duration, ejection fraction, creatinine, and sodium levels).

Outcome

All-cause mortality at 1 and 2 years follow-uphard clinical

The Singapore Heart Failure Risk Score provides a validated, simple clinical tool utilizing 10 readily available variables to accurately predict 1- and 2-year survival in Southeast Asian patients hospitalized for heart failure.

Limitations

Missing data (e.g., NT-proBNP excluded due to ~15% missing data)
Cohort restricted to hospitalized patients (DRG code 252), which may not apply to outpatients and risks misclassification
Included mainly Chinese, Indian, and Malay ethnicities and needs validation in other Asian and Western cohorts
Exact ejection fraction was not available as data was coded into categories
Needs validation in future cohorts due to constant improvements in heart failure management

Abstract

Introduction: Numerous heart failure risk scores have been developed but there is none for Asians. We aimed to develop a risk calculator, the Singapore Heart Failure Risk Score, to predict 1- and 2-year survival in Southeast Asian patients hospitalised for heart failure. Materials and Methods: Consecutive patients admitted for heart failure were identified from the Singapore Cardiac Databank Heart Failure registry. The follow-up was 2 to 4 years and mortality was obtained from national registries. Results: The derivation (2008-2009) and 2 validation cohorts (2008-2009, 2013) included 1392, 729 and 804 patients, respectively. Ten variables were ultimately included in the risk model: age, prior myocardial infarction, prior stroke, atrial fibrillation, peripheral vascular disease, systolic blood pressure, QRS duration, ejection fraction and creatinine and sodium levels. In the derivation cohort, predicted 1- and 2-year survival was 79.1% and 68.1% compared to actual 1- and 2-year survival of 78.2% and 67.9%. There was good agreement between the predicted and observed mortality rates (Hosmer-Lemeshow statistic = 14.36, P = 0.073). C-statistics for 2-year mortality in the derivation and validation cohorts were 0.73 (95% CI, 0.70-0.75) and 0.68 (95% CI, 0.64-0.72), respectively. Conclusion: We provided a risk score based on readily available clinical characteristics to predict 1- and 2-year survival in Southeast Asian patients hospitalised for heart failure via a simple online risk calculator, the Singapore Heart Failure Risk Score. Key words: Asia, Heart failure, Mortality

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