Prediction of incident heart failure in individuals without prior cardiovascular disease: the SCORE2-HF risk model.

Figures

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  Figure 1. Flow diagram describing model development process and data sources. ERFC, Emerging Risk Factors Collaboration; NCD-RisC, NCD Risk Factors Collaboration; CPRD, Clinical Practice Research Datalink; WHO, World Health Organization, HUNT3, Survey 3 of the Trøndelag Health Study

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  Figure 2. C-index results from internal and external validation. CPRD, Clinical Practice Research Datalink; HUNT3, Survey 3 of the Trøndelag Health Study; EstBB, Estonian Biobank; UKB, UK Biobank; ERFC, Emerging Risk Factors Collaboration. For internal validation, 10-fold cross validation revealed minimal optimism in discrimination (optimism in C-index = 0.0003 (95% CI = 0.0002, 0.0003); Supplementary methods)

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  Figure 3. Average SCORE2-HF risk estimates for individuals with 0, 1, 2, 3 or 4 adverse heart failure risk factors, by risk region, sex and age group. Adverse risk factors are: smoking, type 2 diabetes, hypertension (defined as taking antihypertensive medication or systolic blood pressure ≥ 140 mmHg) or body mass index ≥ 30 kg/m2. Each line illustrates the average predicted risk among sex- and age group-specific individuals who have been categorized according to the given definitions of adverse risk factors. However, individual risk estimates within each category depend on the full continuous range of systolic blood pressure, body mass index, estimated glomerular filtration rate and glycated haemoglobin. Individual-specific risks can be estimated using the calculator provided in Supplementary data online, Appendix, and similar electronic calculators or apps, all of which utilise the full range of continuous risk factors. CI, confidence interval, HF, heart failure

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  Figure 4. Comparison of risk classification with SCORE2 and SCORE2-HF. SCORE2-CVD risk groups are determined according to ESC guidelines on cardiovascular disease (CVD) prevention (2021) and CVD and diabetes (2023). In the 2021 guidelines, the ‘intermediate risk group’ is defined as ‘high-risk’ and includes those aged 40 to 49 years at 2.5 to <7.5% 10-year CVD risk, aged 50 to 69 at 5 to <10% risk and those aged 70 years or over at 7.5 to <15% risk. According to the guideline, this high-risk group identifies individuals in whom ‘risk factor treatment should be considered’ and the very high-risk group as those in whom ‘risk factor treatment is generally recommended’. In the 2023 guidelines on CVD and diabetes, the ‘intermediate’ risk group is defined as ‘moderate risk’ and includes individuals with diabetes, with 10-year risk of 5 to <10%. Predicted risk distributions are based on the observed risk factor distributions in individuals from the CPRD

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  Figure 5. Estimated risk distributions using SCORE2-HF in individual countries across Europe. Predicted risk distributions were simulated using age- and sex-specific risk factor value means and prevalences from NCD-RisC and correlation structures observed in cohorts from the Emerging Risk Factors Collaboration