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Performance of Current Risk Stratification Models for Predicting Mortality in Patients with Heart Failure: A Systematic Review and Meta-Analysis

Eur J Prev Cardiol. 2022 Aug 3:zwac148. doi: 10.1093/eurjpc/zwac148. Online ahead of print.


BACKGROUND: There are several risk scores designed to predict mortality in patients with heart failure (HF).

AIM: To assess performance of risk scores validated for mortality prediction in patients with acute HF (AHF) and chronic HF.

METHODS: MEDLINE and Scopus were searched from January 2015 to January 2021 for studies which internally or externally validated risk models for predicting all-cause mortality in patients with AHF and chronic HF. Discrimination data were analyzed using C-statistics, and pooled using generic inverse-variance random-effects model.

RESULTS: Nineteen studies (n = 494,156 patients; AHF:24,762; chronic HF mid-term mortality:62,000; chronic HF long-term mortality:452,097) and 11 risk scores were included. Overall, discrimination of risk scores was good across the three subgroups: AHF mortality (C-statistic:0.76, [0.68-0.83]), chronic HF mid-term mortality (1 year; C-statistic:0.74, [0.68-0.79]) and chronic HF long-term mortality (≥2 years; C-statistic:0.71, [0.69-0.73]). MEESSI-AHF (C-statistic:0.81, [0.80-0.83]) and MARKER-HF (C-statistic:0.85, [0.80-0.89]) had excellent discrimination for AHF and chronic HF mid-term mortality respectively, whereas MECKI had good discrimination (C-statistic:0.78, [0.73-0.83]) for chronic HF long-term mortality relative to other models. Overall, risk scores predicting short-term mortality in patients with AHF did not have evidence of poor calibration (Hosmer-Lemeshow p > 0.05). However, risk models predicting mid-term and long-term mortality in patients with chronic HF varied in calibration performance.

CONCLUSIONS: Majority of recently validated risk scores showed good discrimination for mortality in patients with HF. MEESSI-AHF demonstrated excellent discrimination in patients with AHF, and MARKER-HF and MECKI displayed excellent discrimination in patients with chronic HF. However, modest reporting of calibration and lack of head-to-head comparisons in same populations warrant future studies.

PMID:35919956 | DOI:10.1093/eurjpc/zwac148

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