Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Clin Interv Aging. 2021 Sep 16;16:1669-1677. doi: 10.2147/CIA.S323979. eCollection 2021.
Elderly heart failure (HF) patients have different clinical characteristics and poorer prognosis compared with younger patients. Prognostic risk scores for HF have not been validated well in elderly patients. We aimed to validate the Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score in an elderly Chinese HF cohort.
This retrospective study enrolled 675 elderly HF patients (age≥70 years) discharged from our hospital between 2012 and 2017. The performance of the two risk scores was evaluated in terms of discrimination, using receiver-operating characteristic analysis, and calibration using a calibration plot and Hosmer-Lemeshow (H-L) test. Absolute risk reclassification was used to compare the two scores.
During the mean follow-up time of 32.6 months, 193 patients (28.6%) died, and 1-year mortality was 10.5%. The predicted median 1-year mortality was 8% for the SHFM and 18% for the MAGGIC score. A Kaplan-Meier survival curve demonstrated that event rates of all-cause mortality significantly increased with increasing SHFM and MAGGIC scores. The discriminatory capacity of the SHFM was greater than that of the MAGGIC score (c-statistics were 0.72 and 0.67, respectively; P = 0.05). The calibration plot for the SHFM was better than that for MAGGIC score for 1-year mortality (SHFM: H-L χ =8.2, P = 0.41; MAGGIC: H-L χ =18.8, P =0.02). Compared with the MAGGIC score, the net reclassification index (NRI) of the SHFM was 2.96% (Z=5.88, P< 0.0001).
The SHFM performs better than MAGGIC score, having good discrimination, calibration and risk classification for the prediction of 1-year mortality in elderly Chinese HF patients.
与年轻患者相比，老年心力衰竭（HF）患者具有不同的临床特征和较差的预后。HF 的预后风险评分尚未在老年患者中得到很好的验证。我们旨在验证西雅图心力衰竭模型（SHFM）和荟萃分析全球慢性心力衰竭组（MAGGIC）评分在老年中国 HF 队列中的表现。
这项回顾性研究纳入了 2012 年至 2017 年期间我院出院的 675 名年龄≥70 岁的老年 HF 患者。使用受试者工作特征（ROC）分析评估了两种风险评分的区分能力，使用校准图和 Hosmer-Lemeshow（H-L）检验评估了校准能力。使用绝对风险再分类比较了两种评分。
在平均 32.6 个月的随访期间，193 名患者（28.6%）死亡，1 年死亡率为 10.5%。SHFM 预测的 1 年中位死亡率为 8%，MAGGIC 评分预测的 1 年死亡率为 18%。Kaplan-Meier 生存曲线表明，全因死亡率的事件发生率随着 SHFM 和 MAGGIC 评分的增加而显著增加。SHFM 的区分能力大于 MAGGIC 评分（C 统计量分别为 0.72 和 0.67，P = 0.05）。SHFM 的校准图优于 MAGGIC 评分的 1 年死亡率校准图（SHFM：H-L χ =8.2，P = 0.41；MAGGIC：H-L χ =18.8，P = 0.02）。与 MAGGIC 评分相比，SHFM 的净重新分类指数（NRI）为 2.96%（Z=5.88，P<0.0001）。
SHFM 优于 MAGGIC 评分，对中国老年 HF 患者 1 年死亡率的预测具有良好的区分度、校准度和风险分类。
