Montero-Perez-Barquero Manuel, Manzano Luis, Formiga Francesc, Roughton Michael, Coats Andrew, Rodríguez-Artalejo Fernando, Diez-Manglano Jesus, Bettencourt Paulo, Llacer Pau, Flather Marcus
Department of Internal Medicine, IMIBIC/Hospital Reina Sofia, University of Córdoba, Spain.
Heart Failure and Vascular Risk Unit, Internal Medicine Department, Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain.
Int J Cardiol. 2015 Mar 1;182:449-53. doi: 10.1016/j.ijcard.2014.12.173. Epub 2015 Jan 4.
Heart failure (HF) is predominantly a disease of the elderly. Reliable risk stratification would help in the management of this population, but no model has been well evaluated in elderly HF patients in both acute and chronic settings and not being restricted by ejection fraction. To evaluate the utility of the SENIORS risk model, developed from a clinical trial of elderly patients with chronic HF, in an independent cohort (National Spanish Registry: RICA) of elderly acute HF patients.
We applied the SENIORS risk model to 926 patients in RICA to estimate risk at one year of a) composite outcome of all-cause mortality or cardiovascular hospital admission and b) all-cause mortality.
In the RICA registry mean age was 78years, mean ejection fraction 51% and 87% were in NYHA II and III. At one year death/CV hospitalization occurred in 31.9% and all-cause mortality in 19.5%. The risk model provided good separation of Kaplan Meier curves stratified by tertile for death/CV hospitalization and all-cause mortality. The observed versus expected rates of death/CV hospitalization in the lowest, middle and highest risk tertiles were (%) 34/24, 45/41 and 57/67, and for death 13/16, 32/38 and 44/70 respectively. C-statistic for all-cause mortality or CV hospitalization was 0.60 and for all-cause mortality 0.66.
The SENIORS risk model was a reliable tool for relative risk stratification among acute heart failure patients in a "real world" registry, but predicted versus observed risk showed some variability. The model provides a useful basis for clinical risk prediction.
心力衰竭（HF）主要是一种老年疾病。可靠的风险分层有助于对这一人群进行管理，但尚无模型在老年HF患者的急性和慢性情况下均得到充分评估，且不受射血分数的限制。为了评估从老年慢性HF患者临床试验中开发的SENIORS风险模型在老年急性HF患者的独立队列（西班牙国家注册：RICA）中的效用。
我们将SENIORS风险模型应用于RICA中的926例患者，以估计一年时以下情况的风险：a）全因死亡或心血管住院的复合结局；b）全因死亡。
在RICA注册中心，平均年龄为78岁，平均射血分数为51%，87%的患者为纽约心脏协会（NYHA）II级和III级。一年时，死亡/心血管住院发生率为31.9%，全因死亡率为19.5%。风险模型对按三分位数分层的Kaplan Meier曲线进行了良好的区分，用于死亡/心血管住院和全因死亡率。在最低、中等和最高风险三分位数中，观察到的与预期的死亡/心血管住院率分别为（%）34/24、45/41和57/67，死亡的观察与预期率分别为13/16、32/38和44/70。全因死亡率或心血管住院的C统计量为0.60，全因死亡率的C统计量为0.66。
SENIORS风险模型是在“真实世界”注册中心对急性心力衰竭患者进行相对风险分层的可靠工具，但预测风险与观察到的风险存在一定差异。该模型为临床风险预测提供了有用的基础。
