Diabetes Obes Metab. 2022 Jul 8. doi: 10.1111/dom.14806. Online ahead of print.
ABSTRACT
IMPORTANCE: Early identification and prediction of incident heart failure (HF) is important due to severe morbidity and mortality.
OBJECTIVE: This study aimed to predict onset HF among patients with diabetes.
DESIGN, SETTING, AND PARTICIPANTS: A time-varying Cox model was derived from ACCORD clinical trial to predict the risk of incident HF, defined by hospitalization for HF (HHF). External validation was performed on patient level data from the Harmony Outcome trial and Chronic Renal Insufficiency Cohort (CRIC) study. The model was transformed into integer-based scoring algorithm for 10-year risk evaluation.
EXPOSURES: A stepwise algorithm identified and selected predictors from demographic characteristics, physical examination, laboratory results, medical history, medication, and healthcare utilization, to develop a risk prediction model.
MAIN OUTCOMES AND MEASURES: The main outcome was incident HF, defined by HHF. C statistics and Brier score were used to assess model performance.
RESULTS: A total of 9,649 diabetic patients free of HF were used, with median follow-up of 4 years and 299 incident hospitalization of HF events. The model identified several predictors for the 10-year HF incidence risk score “DM-CURE”: socio-Demographic (education, age at T2DM diagnosis), Metabolic (HbA1c, SBP, BMI, HDL), diabetes-related Complications (MI, revascularization, cardiovascular medications, neuropathy, hypertension duration, albuminuria, UACR, ESKD), and healthcare Utilization (all-cause hospitalization, ER visits) for Risk Evaluation. Among them, the strongest impact factors for future HF were age at T2DM diagnosis, healthcare utilization, and cardiovascular disease-related variables. The model demonstrated good discrimination (C statistic: 0.838, 95% CI: 0.821-0.855) and calibration (Brier score: 0.006, 95% CI: 0.006-0.007) in the ACCORD data and a good performance in the validation data (Harmony: C statistic: 0.881, 95% CI: 0.863-0.899; CRIC: C statistic: 0.813, 95% CI: 0.794-0.833). The 10-year risk of incident HF increased in a graded fashion, from ≤1% in quintile 1 (score ≤ 14), 1-5% in quintile 2 (score 15-23), 5-10% in quintile 3 (score 24-27), 10-20% in quintile 4 (score 28-33), and ≥20% in quintile 5 (score >33).
CONCLUSIONS AND RELEVANCE: The DM-CURE model and score were useful for population risk stratification of incident HHF among patients with T2DM and can be easily applied in clinical practice. This article is protected by copyright. All rights reserved.
PMID:35801340 | DOI:10.1111/dom.14806
