Key result
Adding natriuretic peptides to WATCH-DM improves HF prediction, raising the C-index by ~0.05 points.
Why the study?
The performance of the WATCH-DM risk score in patients with dysglycaemia, alone and combined with natriuretic peptides, had not been evaluated.
Does the addition of natriuretic peptides to the WATCH-DM risk score improve the prediction of incident heart failure in adults with dysglycaemia?
Cohort (n=8,938)
Yes
Does the addition of natriuretic peptides to the WATCH-DM risk score improve the prediction of incident heart failure in adults with dysglycaemia?
The WATCH-DM risk score accurately predicts incident heart failure in individuals with dysglycaemia, and the addition of natriuretic peptides provides the greatest incremental predictive value in those at low-to-intermediate risk.
May aid HF risk stratification in dysglycaemia; extends WATCH-DM but remains hypothesis-generating pending prospective validation.
AIMS: To evaluate the performance of the WATCH-DM risk score, a clinical risk score for heart failure (HF), in patients with dysglycaemia and in combination with natriuretic peptides (NPs). METHODS AND RESULTS: Adults with diabetes/pre-diabetes free of HF at baseline from four cohort studies (ARIC, CHS, FHS, and MESA) were included. The machine learning- [WATCH-DM(ml)] and integer-based [WATCH-DM(i)] scores were used to estimate the 5-year risk of incident HF. Discrimination was assessed by Harrell's concordance index (C-index) and calibration by the Greenwood-Nam-D'Agostino (GND) statistic. Improvement in model performance with the addition of NP levels was assessed by C-index and continuous net reclassification improvement (NRI). Of the 8938 participants included, 3554 (39.8%) had diabetes and 432 (4.8%) developed HF within 5 years. The WATCH-DM(ml) and WATCH-DM(i) scores demonstrated high discrimination for predicting HF risk among individuals with dysglycaemia (C-indices = 0.80 and 0.71, respectively), with no evidence of miscalibration (GND P ≥0.10). The C-index of elevated NP levels alone for predicting incident HF among individuals with dysglycaemia was significantly higher among participants with low/intermediate (<13) vs. high (≥13) WATCH-DM(i) scores [0.71 (95% confidence interval 0.68-0.74) vs. 0.64 (95% confidence interval 0.61-0.66)]. When NP levels were combined with the WATCH-DM(i) score, HF risk discrimination improvement and NRI varied across the spectrum of risk with greater improvement observed at low/intermediate risk [WATCH-DM(i) <13] vs. high risk [WATCH-DM(i) ≥13] (C-index = 0.73 vs. 0.71; NRI = 0.45 vs. 0.17). CONCLUSION: The WATCH-DM risk score can accurately predict incident HF risk in community-based individuals with dysglycaemia. The addition of NP levels is associated with greater improvement in the HF risk prediction performance among individuals with low/intermediate risk than those with high risk.
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Segar et al. (2021) conducted a cohort in Dysglycaemia (diabetes or pre-diabetes) (n=8,938). Addition of natriuretic peptide (NP) levels to the WATCH-DM risk score vs. WATCH-DM risk score alone was evaluated on Incident heart failure risk prediction accuracy (C-index) (C-index 0.76, 95% CI 0.74-0.78, p=<0.001). The addition of natriuretic peptide levels to the WATCH-DM risk score significantly improved the 5-year prediction of incident heart failure, increasing the overall C-index from 0.71 to 0.76, with the greatest reclassification improvement observed in low/intermediate risk individuals.
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