Key result
Black race linked to ~34% lower mortality in heart failure despite similar MAGGIC discrimination.
Why the study?
Few patients self-identified as black in the derivation of the MAGGIC risk score, creating uncertainty regarding its performance in black patients with heart failure.
Does the MAGGIC score accurately predict all-cause mortality in Black patients with heart failure compared to White patients, and how does survival differ by race?
Cohort (n=4,046)
No
Does the MAGGIC score accurately predict all-cause mortality in Black patients with heart failure compared to White patients, and how does survival differ by race?
The MAGGIC score is a valid tool for risk-stratifying African American patients with heart failure, demonstrating comparable discrimination to that seen in White patients.
Answers are grounded in this paper and cite their sources.
Supports MAGGIC for HF risk stratification across races; extends validation to Black patients but leaves practice change open.
BACKGROUND: Risk stratification is critical in heart failure (HF) and the Meta-Analysis Global Group in Chronic HF (MAGGIC) score is a validated tool derived from ~40,000 patients. However, few of these patients self-identified as black, raising uncertainty regarding performance in blacks with HF. METHODS AND RESULTS: This study analyzed a racially diverse group of 4046 patients (1646 black and 2400 white) from a single center from 2007 to 2015. Baseline characteristics were collected to tabulate MAGGIC score and test its discrimination and calibration within race groups. The primary end point was all-cause mortality. Death was detected using system records and the social security death master file. Discrimination was tested using Cox models of MAGGIC score stratified by race, and combined analysis including MAGGIC, race, and MAGGIC×race. Calibration was assessed using linear regression models and plots of observed versus predicted data. Overall, 901 (21%) patients died during 1-year follow-up. MAGGIC score discrimination was similar in both race groups in terms of C statistic (0.707±0.027 versus 0.725±0.014, for black versus white; P=0.556) and the hazard ratio (HR) per MAGGIC point was 1.12 in black patients (95% CI, 1.10-1.14) and 1.13 in white patients (95% CI, 1.12-1.14). Race was a significant correlate of survival, with better survival in black patients compared with white (HR, 0.66; 95% CI, 0.56-0.78), but the interaction of MAGGIC×race was not significant (β=-0.013; P=0.16), and adding race to the model did not improve discrimination (C statistic for MAGGIC versus MAGGIC+race, 0.721 versus 0.722; P=0.79). In calibration testing, the slope was not significantly different from 1 in either group, but the groups differed from each other, and it was closer to unity among black patients (0.94 versus 1.4; P=0.004). CONCLUSIONS: These data support the use of the MAGGIC score to risk stratify black patients with HF.
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Radjef et al. (2019) conducted a cohort in Heart failure (n=4,046). Black race vs. White race was evaluated on All-cause mortality (HR 0.66, 95% CI 0.56-0.78, p=<0.001). The MAGGIC score showed similar mortality risk discrimination in Black and White patients with heart failure, although Black patients had significantly better overall survival (HR 0.66).
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