Eur J Heart Fail. 2021 Nov 3. doi: 10.1002/ejhf.2375. Online ahead of print.
ABSTRACT
AIMS: To evaluate the performance of the WATCH-DM risk score, a clinical risk score for heart failure (HF), in patients with dysglycemia and in combination with natriuretic peptides (NP).
METHODS AND RESULTS: Adults with diabetes/pre-diabetes free of HF at baseline from 4 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 dysglycemia (C-indices = 0.80 and 0.71) respectively, with no evidence of miscalibration (GND P-value ≥0.10). The C-index of elevated NP-levels alone for predicting incident HF among individuals with dysglycemia was significantly higher among participants with low/intermediate (<13) vs. high (≥13) WATCH-DM(i) scores [0.71(95%CI = 0.68-0.74) vs. 0.64(95%CI = 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, respectively).
CONCLUSION: The WATCH-DM risk score can accurately predict incident HF risk in community-based individuals with dysglycemia. 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. This article is protected by copyright. All rights reserved.
PMID:34730265 | DOI:10.1002/ejhf.2375
