Key result
WATCH-DM and TRS-HF DM scores moderately predict 5-year incident HF risk in T2D.
Why the study?
The WATCH-DM and TRS-HF DM risk scores were developed to predict heart failure risk in type 2 diabetes, but comparative model performance across cohorts with varying baseline risk needed evaluation.
Do the WATCH-DM and TRS-HF DM risk scores accurately predict incident heart failure in patients with type 2 diabetes?
Cohort (n=24,370)
Yes
Do the WATCH-DM and TRS-HF DM risk scores accurately predict incident heart failure in patients with type 2 diabetes?
The WATCH-DM and TRS-HF DM risk scores provide moderate discrimination for predicting incident heart failure in intermediate-risk patients with type 2 diabetes.
Moderate discrimination limits routine clinical use of WATCH-DM and TRS-HF DM scores in type 2 diabetes; leaves open need for refined models in prospective studies.
Background The WATCH‐DM (weight [body mass index], age, hypertension, creatinine, high‐density lipoprotein cholesterol, diabetes control [fasting plasma glucose], ECG QRS duration, myocardial infarction, and coronary artery bypass grafting) and TRS‐HF DM (Thrombolysis in Myocardial Infarction [TIMI] risk score for heart failure in diabetes) risk scores were developed to predict risk of heart failure (HF) among individuals with type 2 diabetes. WATCH‐DM was developed to predict incident HF, whereas TRS‐HF DM predicts HF hospitalization among patients with and without a prior HF history. We evaluated the model performance of both scores to predict incident HF events among patients with type 2 diabetes and no history of HF hospitalization across different cohorts and clinical settings with varying baseline risk. Methods and Results Incident HF risk was estimated by the integer‐based WATCH‐DM and TRS‐HF DM scores in participants with type 2 diabetes free of baseline HF from 2 randomized clinical trials (TECOS [Trial Evaluating Cardiovascular Outcomes With Sitagliptin], N=12 028; and Look AHEAD [Look Action for Health in Diabetes] trial, N=4867). The integer‐based WATCH‐DM score was also validated in electronic health record data from a single large health care system (N=7475). Model discrimination was assessed by the Harrell concordance index and calibration by the Greenwood‐Nam‐D’Agostino statistic. HF incidence rate was 7.5, 3.9, and 4.1 per 1000 person‐years in the TECOS, Look AHEAD trial, and electronic health record cohorts, respectively. Integer‐based WATCH‐DM and TRS‐HF DM scores had similar discrimination and calibration for predicting 5‐year HF risk in the Look AHEAD trial cohort (concordance indexes=0.70; Greenwood‐Nam‐D’Agostino P >0.30 for both). Both scores had lower discrimination and underpredicted HF risk in the TECOS cohort (concordance indexes=0.65 and 0.66, respectively; Greenwood‐Nam‐D’Agostino P <0.001 for both). In the electronic health record cohort, the integer‐based WATCH‐DM score demonstrated a concordance index of 0.73 with adequate calibration (Greenwood‐Nam‐D’Agostino P =0.96). TRS‐HF DM score could not be validated in the electronic health record because of unavailability of data on urine albumin/creatinine ratio in most patients in the contemporary clinical practice. Conclusions The WATCH‐DM and TRS‐HF DM risk scores can discriminate risk of HF among intermediate‐risk populations with type 2 diabetes.
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Segar et al. (2022) conducted a cohort in Type 2 diabetes (n=24,370). WATCH-DM and TRS-HF DM risk scores was evaluated on Incident heart failure. The WATCH-DM and TRS-HF DM risk scores demonstrated moderate discrimination for predicting 5-year incident heart failure risk among patients with type 2 diabetes, with concordance indexes of 0.65-0.73.
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