November 3, 2021European Journal of Heart Failure45 citationsOpen Access
View Full PaperIncorporation of natriuretic peptides with clinical risk scores to predict heart failure among individuals with dysglycaemia
Key Result
Adding natriuretic peptide levels to the WATCH-DM risk score improved 5-year incident heart failure risk prediction more in individuals with low/intermediate risk (NRI 0.45) than high risk.
Study Design
Type
Cohort (n=8,938)
Multicenter
Yes
Structured PICO
Does the addition of natriuretic peptides to the WATCH-DM risk score improve the prediction of incident heart failure in adults with dysglycaemia?
P
Population
8,938 adults with diabetes or pre-diabetes, free of heart failure at baseline, evaluated for 5-year risk of incident heart failure.
E
Exposure
WATCH-DM risk score (machine learning and integer-based) combined with natriuretic peptide (NP) levels
C
Comparator
WATCH-DM risk score alone
O
Outcome
5-year risk of incident heart failurehard clinical
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.
Abstract
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.