Risk prediction in patients with heart failure with preserved ejection fraction: the LIFE-Preserved model.
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Reitsma Tessa H, Savarese Gianluigi, Kuźma Łukasz, Deo Salil V, Pennells Lisa, Hageman Steven H J, Holtrop Joris, Benson Lina, Conrad Nathalie, Lund Lars H, Kurasz Anna, Kaptoge Stephen, Keene Spencer J, Chilala Chimweta, Pitt Matilda, Fletcher Robert A, Khunti Kamlesh, Piepoli Massimo, Rossello Xavier, Lees Jennifer S, Kavousi Maryam, McEvoy John William, Wood Angela M, de Boer Rudolf A, Andersson Charlotte, Visseren Frank L J, Koudstaal Stefan, Di Angelantonio Emanuele, Dorresteijn Jannick A N, CVD-COVID-UK/COVID-IMPACT Consortium, ESC Cardiovascular Risk Collaboration
Аннотация
METHODS: LIFE-Preserved was derived in 20 332 patients aged 40-90 years with a left ventricular ejection fraction ≥ 50% from the Swedish HF Registry. Cause- and sex-specific Cox models were derived to predict the risk of HF hospitalization or CV death using 14 routinely available predictors. Use of age as the timescale allowed for predictions beyond the maximum follow-up duration in the derivation data, adjusted for competing risks. External validation was performed in two trials (EMPEROR-Preserved and TOPCAT-Americas) and three registries (NHS England Secure Data Environment, Veterans Affairs, and HF-Particles). Model performance was assessed by discrimination and calibration.
RESULTS: During a median follow-up of 1.8 years (interquartile range .6-4.2, maximum 19 years), 9341 first HF hospitalizations or CV deaths (46%) were observed in Swedish HF Registry. External validation included data from 28 062 patients with HFpEF [9930 (35%) first HF hospitalizations or CV deaths]. Pooled C-statistics were .714 (95% confidence interval .652-.775) in trials and .658 (95% confidence interval .599-.717 in registries, with adequate calibration in all external validation sources. Performance was similar in men and women. An interactive calculator of the LIFE-Preserved model has been made available here.
CONCLUSIONS: The LIFE-Preserved model enables prediction of short-term and lifetime risk of HF hospitalization or CV death in patients with HFpEF. The model could serve as a tool to identify high-risk HFpEF patients, guiding clinical management and shared decision-making.