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. 2023 Oct;10(5):2875-2881.
doi: 10.1002/ehf2.14400. Epub 2023 Jul 8.

Heart failure risk scores in advanced heart failure patients: insights from the LEVO-D registry

Pau Codina  1   2 , David Dobarro  3 , Javier de Juan-Bagudá  4   5   6 , Fernando De Frutos  7 , Josep Lupón  1   2   6 , Antoni Bayes-Genis  1   2   6 , José Gonzalez-Costello  6   7   8 ; Spanish LEVO‐D registry Collaborators
Collaborators, Affiliations

Heart failure risk scores in advanced heart failure patients: insights from the LEVO-D registry

Pau Codina et al. ESC Heart Fail. 2023 Oct.

Abstract

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.

Keywords: Advanced heart failure; Mortality; Risk models; Risk prediction.

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Conflict of interest statement

D.D., J.G.C., and J.J.B received speaker fees from Orion. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Calibration plots with LOWESS lines comparing observed versus expected events at 1 year by each calculator. Caption: Y axis, observed mortality; X axis, expected mortality; dashed line represents best fitting curve; LOWESS smoother curve (blue line) allows assessing calibration at individual patient level; circles represents groups automatically created by the test.
Figure 2
Figure 2
Survival curves based on quartiles of risk estimation by every tool.
See this image and copyright information in PMC

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