Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
J Card Fail. 2018 Nov;24(11):735-745. doi: 10.1016/j.cardfail.2017.11.002. Epub 2017 Nov 22.
Prognostic evaluation in heart failure (HF) is important to predict future events and decide timely management. Many HF patients are treated with the use of an implantable cardioverter-defibrillator (ICD). This study aimed to validate a meta-analytically derived prognostic score to predict survival in ICD-HF patients.
The HF Meta-score includes 14 independent mortality predictors identified in a meta-analysis, including age, sex, ethnicity, diabetes, chronic obstructive pulmonary disease, peripheral vascular disease, atrial fibrillation, ischemic cardiomyopathy, history of HF admission, New York Heart Association functional class, left ventricular ejection fraction, renal function, QRS duration, secondary prevention indication, and ICD shocks. The HF Meta-score performance was evaluated in comparison with the Seattle Heart Failure Model (SHFM) and the SHOCKED predictors in a cohort of 9860 ambulatory ICD patients from the Ontario provincial database for 2007-2011. During 3-year follow-up, 1816 patients died. The HF Meta-score showed excellent calibration, very good discrimination (c-statistic 0.74) and enhanced risk classification compared with the SHOCKED predictors, with better reclassifying in 19% and 56% of patients for 1- and 3-year survival, respectively. HF Meta-score performance was similar to the SHFM.
The HF Meta-score is an evidence-based derived model that provides an accurate prognosis assessment in HF patients with ICDs. Its development strategy permits further incorporation of new predictors when evidence becomes available.
心力衰竭（HF）的预后评估对于预测未来事件和及时做出管理决策非常重要。许多 HF 患者使用植入式心脏复律除颤器（ICD）进行治疗。本研究旨在验证一种通过荟萃分析得出的预后评分，以预测 ICD-HF 患者的生存情况。
HF Meta 评分包括在荟萃分析中确定的 14 个独立死亡率预测因素，包括年龄、性别、种族、糖尿病、慢性阻塞性肺疾病、外周血管疾病、心房颤动、缺血性心肌病、HF 入院史、纽约心脏协会功能分级、左心室射血分数、肾功能、QRS 持续时间、二级预防指征和 ICD 电击。在 2007 年至 2011 年安大略省数据库中对 9860 例门诊 ICD 患者的队列中，与西雅图心力衰竭模型（SHFM）和 SHOCKED 预测因素进行了 HF Meta 评分性能评估。在 3 年随访期间，1816 例患者死亡。HF Meta 评分显示出极好的校准能力、非常好的区分能力（c 统计量为 0.74）和增强的风险分类能力，与 SHOCKED 预测因素相比，1 年和 3 年生存率分别有 19%和 56%的患者更好地重新分类。HF Meta 评分的性能与 SHFM 相似。
HF Meta 评分是一种基于证据的衍生模型，可对 HF 合并 ICD 的患者进行准确的预后评估。其开发策略允许在有新证据时进一步纳入新的预测因素。
