Identifying patients at increased risk for poor outcomes from heart failure with reduced ejection fraction: the PROMPT-HF risk model.

AIMS

We aimed to develop a risk prediction tool that incorporated both clinical events and worsening health status for patients with heart failure (HF) with reduced ejection fraction (HFrEF). Identifying patients with HFrEF at increased risk of a poor outcome may enable proactive interventions that improve outcomes.

METHODS AND RESULTS

We used data from a longitudinal HF registry, CHAMP-HF, to develop a risk prediction tool for poor outcomes over the next 6 months. A poor outcome was defined as death, an HF hospitalization, or a ≥20-point decrease (or decrease below 25) in 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) overall summary score. Among 4546 patients in CHAMP-HF, 1066 (23%) experienced a poor outcome within 6 months (1.3% death, 11% HF hospitalization, and 11% change in KCCQ-12). The model demonstrated moderate discrimination (c-index = 0.65) and excellent calibration with observed data. The following variables were associated with a poor outcome: age, race, education, New York Heart Association class, baseline KCCQ-12, atrial fibrillation, coronary disease, diabetes, chronic kidney disease, smoking, prior HF hospitalization, and systolic blood pressure. We also created a simplified model with a 0-10 score using six variables (New York Heart Association class, KCCQ-12, coronary disease, chronic kidney disease, prior HF hospitalization, and systolic blood pressure) with similar discrimination (c-index = 0.63). Patients scoring 0-3 were considered low risk (event rate <20%), 4-6 were considered intermediate risk (event rate 20-40%), and 7-10 were considered high risk (event rate >40%).

CONCLUSIONS

The PROMPT-HF risk model can identify outpatients with HFrEF at increased risk of poor outcomes, including clinical events and health status deterioration. With further validation, this model may help inform therapeutic decision making.