Key result
BCN-Bio-HF and MAGGIC-HF risk scores underestimate 1-year mortality and show suboptimal discrimination in advanced HF.
Why the study?
Data were scarce on the accuracy of web-based heart failure risk scores in patients with advanced heart failure.
Do the MAGGIC-HF and BCN-Bio-HF risk scores accurately predict 1-year mortality in advanced HF patients receiving intermittent levosimendan as destination therapy?
Observational (n=403)
Yes
Do the MAGGIC-HF and BCN-Bio-HF risk scores accurately predict 1-year mortality in advanced HF patients receiving intermittent levosimendan as destination therapy?
Existing HF risk scores (MAGGIC-HF and BCN-Bio-HF) underestimate mortality and have suboptimal discrimination in advanced HF patients on intermittent levosimendan, highlighting the need for specific scores in this population.
Risk scores should not guide prognosis in advanced HF on levosimendan; leaves open need for dedicated models in this population.
AIMS: The prevalence of advanced heart failure (HF) is increasing due to the growing number of patients with HF and their better treatment and survival. There is a scarcity of data on the accuracy of HF web-based risk scores in this selected population. This study aimed to assess mortality prediction performance of the Meta-Analysis Global Group in Chronic HF (MAGGIC-HF) risk score and the model of the Barcelona Bio-HF Risk Calculator (BCN-Bio-HF) containing N terminal pro brain natriuretic peptide in HF patients receiving intermittent inotropic support with levosimendan as destination therapy. METHODS AND RESULTS: Four hundred and three advanced HF patients from 23 tertiary hospitals in Spain receiving intermittent inotropic support with levosimendan as destination therapy were included. Discrimination for all-cause mortality was compared by area under the curve (AUC) and Harrell's C-statistic at 1 year. Calibration was assessed by calibration plots comparing observed versus expected events based on estimated risk by each calculator. The included patients were predominantly men, aged 71.5 [interquartile range 64-78] years, with reduced left ventricular ejection fraction (27.5 ± 9.4%); ischaemic heart disease was the most prevalent aetiology (52.5%). Death rate at 1 year was 26.8%, while the predicted 1-year mortality by BCN-Bio-HF and MAGGIC-HF was 17.0% and 22.1%, respectively. BCN-Bio-HF AUC was 0.66 (Harrell's C-statistic 0.64), and MAGGIC-HF AUC was 0.62 (Harrell's C-statistic 0.61). CONCLUSIONS: The two evaluated risk scores showed suboptimal discrimination and calibration with an underestimation of risk in advanced HF patients receiving levosimendan as destination therapy. There is a need for specific scores for advanced HF.
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Codina et al. (2023) conducted an observational in Advanced heart failure (n=403). MAGGIC-HF and BCN-Bio-HF risk scores was evaluated on All-cause mortality at 1 year (BCN-Bio-HF AUC 0.66; MAGGIC-HF AUC 0.62). The BCN-Bio-HF and MAGGIC-HF risk scores underestimated 1-year mortality (predicted 17.0% and 22.1% vs observed 26.8%) and showed suboptimal discrimination (AUC 0.66 and 0.62) in advanced HF.
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