Advanced heart failure definitions incorporating NT-proBNP ≥2000 pg/ml achieved the highest prognostic accuracy (AUC = 0.75) compared to HFA (AUC = 0.72) and GALACTIC-Severe (AUC = 0.73) criteria.
How do different definitions of severe and advanced heart failure compare in their prevalence and prognostic performance for 1-year outcomes in patients with HFrEF?
Incorporating NT-proBNP levels ≥2000 pg/ml into advanced heart failure definitions provides the highest prognostic accuracy for identifying high-risk HFrEF patients.
Absolute Event Rate: 0% vs 0%
Background A valid definition of severe heart failure (HF) is essential for earlier identification, timely referral for advanced therapies, and to optimize clinical trial design.Objectives To assess the prevalence, prognostic performance, and 1-year outcomes associated with different definitions of severe and advanced HF (AdvHF) in patients with heart failure with reduced ejection fraction (HFrEF).Methods We included 15,153 patients with EF 6 months, and no prior left ventricular assist device or heart transplant, from the Swedish Heart Failure Registry. Several definitions of severe/AdvHF were evaluated: a simplified Heart Failure Association (HFA) definition (NYHA III-IV, EF <30%, ≥2 HF hospitalizations in 12 months), the GALACTIC-Severe-definition (NYHA III-IV, EF <30%, ≥1 hospitalization in 6 months), and variations adding/removing criteria such as NT-proBNP levels and diuretic dose to the HFA-AdvHF definition. Predictive performance and 1-year outcomes were analyzed.Results The HFA-definition identified 6.4% of patients, with a 1-year cardiovascular death/HF hospitalization risk of 70% and all-cause mortality of 45% (AUC = 0.72). The GALACTIC-Severe definition identified 12.6% of patients with slightly lower but still substantial event rates (59% and 38%, respectively; AUC = 0.73). Definitions incorporating NT-proBNP ≥2000 pg/ml had the highest prognostic accuracy (AUC = 0.75).Conclusions The HFA-AdvHF definition selected a smaller, high-risk group, while the GALACTIC-Severe criteria identified a broader population, with a lower, but still high risk. NT-proBNP, HF hospitalization history, and diuretic dose might represent valuable enrichment tools for future trials.
Guidetti et al. (Wed,) reported a other. Advanced heart failure definitions incorporating NT-proBNP ≥2000 pg/ml achieved the highest prognostic accuracy (AUC = 0.75) compared to HFA (AUC = 0.72) and GALACTIC-Severe (AUC = 0.73) criteria.