Key result
High MAGGIC score linked to ~3.7-fold higher competing non-sudden death in HFrEF ICD recipients.
Why the study?
The role of prognostic risk scores in predicting the competing risk of non-sudden death in patients with HFrEF receiving an ICD is unclear.
Does the MAGGIC prognostic risk score accurately predict the competing risk of non-sudden death versus appropriate ICD therapy in HFrEF patients receiving an ICD?
Cohort (n=1,089)
Yes
Does the MAGGIC prognostic risk score accurately predict the competing risk of non-sudden death versus appropriate ICD therapy in HFrEF patients receiving an ICD?
The MAGGIC risk score effectively identifies HFrEF ICD candidates at high competing risk of non-sudden death who are less likely to derive benefit from defibrillator therapy, supporting mortality risk estimation at the time of ICD implantation.
MAGGIC score may identify high competing mortality risk in HFrEF ICD recipients; leaves open its role in guiding therapy decisions.
The role of prognostic risk scores in predicting the competing risk of non-sudden death in heart failure patients with reduced ejection fraction (HFrEF) receiving an implantable cardioverter-defibrillator (ICD) is unclear. To this goal, we evaluated the accuracy and usefulness of the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. The present analysis included 1089 HFrEF ICD recipients enrolled in the OBSERVO-ICD registry (NCT02735811). During a median follow-up of 36 months (1st–3rd IQR 25–48 months), 193 patients (17.7%) experienced at least one appropriate ICD therapy, and 133 patients died (12.2%) without experiencing any ICD therapy. The frequency of patients receiving ICD therapies was stable around 17–19% across increasing tertiles of 3-year MAGGIC probability of death, whereas non-sudden mortality increased (6.4% to 9.8% to 20.8%, p < 0.0001). Accuracy of MAGGIC score was 0.60 (95% CI, 0.56–0.64) for the overall outcome, 0.53 (95% CI, 0.49–0.57) for ICD therapies and 0.65 (95% CI, 0.60–0.70) for non-sudden death. In patients with higher 3-year MAGGIC probability of death, the increase in the competing risk of non-sudden death during follow-up was greater than that of receiving an appropriate ICD therapy. Results were unaffected when analysis was limited to ICD shocks only. The MAGGIC risk score proved accurate and useful in predicting the competing risk of non-sudden death in HFrEF ICD recipients. Estimation of mortality risk should be taken into greater consideration at the time of ICD implantation.
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Canepa et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) receiving an implantable cardioverter-defibrillator (ICD) (n=1,089). MAGGIC score high-risk tertile (3-year predicted mortality >39%) vs. MAGGIC score low-risk tertile (<23%) and mid-risk tertile (23-39%) was evaluated on Competing risk of non-sudden death (non-sudden cardiac and non-cardiac death occurring prior to ICD therapy) (sHR 3.67 (high vs. low risk); ROC AUC 0.65, 95% CI 2.28-5.90, p=<0.0001). The MAGGIC score predicted competing non-sudden death in HFrEF ICD recipients (AUC 0.65; high vs low risk sHR 3.67, 95% CI 2.28-5.90, p<0.0001) but not appropriate ICD therapy (AUC 0.53).
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