Key result
MEESSI-AHF shows excellent mortality discrimination in acute HF with a ~0.81 C-statistic.
Why the study?
Several risk scores exist to predict mortality in heart failure, but their comparative performance across acute and chronic heart failure required systematic evaluation.
Do current risk stratification models accurately predict mortality in patients with acute and chronic heart failure?
Meta-Analysis (n=494,156)
Do current risk stratification models accurately predict mortality in patients with acute and chronic heart failure?
Effect estimate: C-statistic 0.76 (95% CI 0.68-0.83)
Current risk stratification models, particularly MEESSI-AHF, MARKER-HF, and MECKI, demonstrate good to excellent discrimination for predicting mortality in patients with acute and chronic heart failure.
Validated HF risk models support mortality stratification in practice; reinforces MEESSI-AHF utility and guides further refinement.
AIMS: There are several risk scores designed to predict mortality in patients with heart failure (HF). This study aimed to assess performance of risk scores validated for mortality prediction in patients with acute HF (AHF) and chronic HF. METHODS AND RESULTS: MEDLINE and Scopus were searched from January 2015 to January 2021 for studies which internally or externally validated risk models for predicting all-cause mortality in patients with AHF and chronic HF. Discrimination data were analysed using C-statistics, and pooled using generic inverse-variance random-effects model. Nineteen studies (n = 494 156 patients; AHF: 24 762; chronic HF mid-term mortality: 62 000; chronic HF long-term mortality: 452 097) and 11 risk scores were included. Overall, discrimination of risk scores was good across the three subgroups: AHF mortality [C-statistic: 0.76 (0.68-0.83)], chronic HF mid-term mortality [1 year; C-statistic: 0.74 (0.68-0.79)], and chronic HF long-term mortality [≥2 years; C-statistic: 0.71 (0.69-0.73)]. MEESSI-AHF [C-statistic: 0.81 (0.80-0.83)] and MARKER-HF [C-statistic: 0.85 (0.80-0.89)] had an excellent discrimination for AHF and chronic HF mid-term mortality, respectively, whereas MECKI had good discrimination [C-statistic: 0.78 (0.73-0.83)] for chronic HF long-term mortality relative to other models. Overall, risk scores predicting short-term mortality in patients with AHF did not have evidence of poor calibration (Hosmer-Lemeshow P > 0.05). However, risk models predicting mid-term and long-term mortality in patients with chronic HF varied in calibration performance. CONCLUSIONS: The majority of recently validated risk scores showed good discrimination for mortality in patients with HF. MEESSI-AHF demonstrated excellent discrimination in patients with AHF, and MARKER-HF and MECKI displayed an excellent discrimination in patients with chronic HF. However, modest reporting of calibration and lack of head-to-head comparisons in same populations warrant future studies.
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Siddiqi et al. (2022) conducted a meta-analysis in heart failure (n=494,156). Risk stratification models was evaluated on All-cause mortality prediction (discrimination) (C-statistic 0.76, 95% CI 0.68-0.83). Risk stratification models showed good discrimination for mortality in heart failure, with MEESSI-AHF demonstrating excellent discrimination in acute HF (C-statistic 0.81; 95% CI 0.80-0.83).
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