Cardiology Unit, Department of Internal Medicine, University of Genova, and Ospedale Policlinico San Martino IRCCS, Genova, Italy.
Heart Failure Management Programme, S. Francisco Xavier Hospital, CHLO. NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
JACC Heart Fail. 2018 Jun;6(6):452-462. doi: 10.1016/j.jchf.2018.02.001.
This study compared the performance of major heart failure (HF) risk models in predicting mortality and examined their utilization using data from a contemporary multinational registry.
Several prognostic risk scores have been developed for ambulatory HF patients, but their precision is still inadequate and their use limited.
This registry enrolled patients with HF seen in participating European centers between May 2011 and April 2013. The following scores designed to estimate 1- to 2-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), and SHFM (Seattle Heart Failure Model). Patients with hospitalized HF (n = 6,920) and ambulatory HF patients missing any variable needed to estimate each score (n = 3,267) were excluded, leaving a final sample of 6,161 patients.
At 1-year follow-up, 5,653 of 6,161 patients (91.8%) were alive. The observed-to-predicted survival ratios (CHARM: 1.10, GISSI-HF: 1.08, MAGGIC: 1.03, and SHFM: 0.98) suggested some overestimation of mortality by all scores except the SHFM. Overprediction occurred steadily across levels of risk using both the CHARM and the GISSI-HF, whereas the SHFM underpredicted mortality in all risk groups except the highest. The MAGGIC showed the best overall accuracy (area under the curve [AUC] = 0.743), similar to the GISSI-HF (AUC = 0.739; p = 0.419) but better than the CHARM (AUC = 0.729; p = 0.068) and particularly better than the SHFM (AUC = 0.714; p = 0.018). Less than 1% of patients received a prognostic estimate from their enrolling physician.
Performance of prognostic risk scores is still limited and physicians are reluctant to use them in daily practice. The need for contemporary, more precise prognostic tools should be considered.
本研究比较了主要心力衰竭（HF）风险模型在预测死亡率方面的性能，并利用来自当代多国登记处的数据检查了它们的使用情况。
已经为门诊 HF 患者开发了几种预后风险评分，但它们的精度仍然不足，使用受限。
该登记处招募了 2011 年 5 月至 2013 年 4 月期间在参与欧洲中心就诊的 HF 患者。在每个参与者中计算了以下旨在估计 1 至 2 年全因死亡率的评分：CHARM（坎地沙坦在心力衰竭评估中的死亡率降低）、GISSI-HF（Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico-Heart Failure）、MAGGIC（Meta-analysis Global Group in Chronic Heart Failure）和 SHFM（西雅图心力衰竭模型）。排除了患有住院 HF（n=6920）和门诊 HF 患者的任何需要估计每个评分的变量（n=3267），最终样本为 6161 例患者。
在 1 年随访时，6161 例患者中有 5653 例（91.8%）存活。观察到的与预测的生存率比值（CHARM：1.10，GISSI-HF：1.08，MAGGIC：1.03，SHFM：0.98）表明，除了 SHFM 外，所有评分都存在一定程度的死亡率高估。使用 CHARM 和 GISSI-HF，风险水平的过度预测是稳定的，而 SHFM 除了最高风险组外，死亡率预测均偏低。MAGGIC 显示出最佳的整体准确性（曲线下面积 [AUC] = 0.743），与 GISSI-HF（AUC = 0.739；p = 0.419）相似，但优于 CHARM（AUC = 0.729；p = 0.068），特别是优于 SHFM（AUC = 0.714；p = 0.018）。不到 1%的患者从其登记医生那里获得了预后估计。
预后风险评分的性能仍然有限，医生不愿在日常实践中使用它们。应该考虑使用现代、更精确的预后工具。
