Blum Moritz, Gelfman Laura P, McKendrick Karen, Pinney Sean P, Goldstein Nathan E
Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Front Cardiovasc Med. 2022 Apr 11;9:836237. doi: 10.3389/fcvm.2022.836237. eCollection 2022.
Score-based survival prediction in patients with advanced heart failure (HF) is complicated. Easy-to-use prognostication tools could inform clinical decision-making and palliative care delivery.
To compare the prognostic utility of the Seattle HF model (SHFM), the surprise question (SQ), and the number of HF hospitalizations (NoH) within the last 12 months for predicting 1-year survival in patients with advanced HF.
We retrospectively analyzed data from a cluster-randomized controlled trial of advanced HF patients, predominantly with reduced ejection fraction. Primary outcome was the prognostic discrimination of SHFM, SQ ("Would you be surprised if this patient were to die within 1 year?") answered by HF cardiologists, and NoH, assessed by receiver operating characteristic (ROC) curve analysis. Optimal cut-offs were calculated using Youden's index (SHFM: <86% predicted 1-year survival; NoH ≥ 2).
Of 535 subjects, 82 (15.3%) had died after 1-year of follow-up. SHFM, SQ, and NoH yielded a similar area under the ROC curve [SHFM: 0.65 (0.60-0.71 95% CI); SQ: 0.58 (0.54-0.63 95% CI); NoH: 0.56 (0.50-0.62 95% CI)] and similar sensitivity [SHFM: 0.76 (0.65-0.84 95% CI); SQ: 0.84 (0.74-0.91 95% CI); NoH: 0.56 (0.45-0.67 95% CI)]. As compared to SHFM, SQ had lower specificity [SQ: 0.33 (0.28-0.37 95% CI) vs. SHFM: 0.55 (0.50-0.60 95% CI)] while NoH had similar specificity [0.56 (0.51-0.61 95% CI)]. SQ combined with NoH showed significantly higher specificity [0.68 (0.64-0.73 95% CI)].
SQ and NoH yielded comparable utility to SHFM for 1-year survival prediction among advanced HF patients, are easy-to-use and could inform bedside decision-making.
晚期心力衰竭（HF）患者基于评分的生存预测较为复杂。易于使用的预后工具可为临床决策和姑息治疗提供依据。
比较西雅图心力衰竭模型（SHFM）、意外问题（SQ）以及过去12个月内心力衰竭住院次数（NoH）对晚期HF患者1年生存率预测的预后效用。
我们回顾性分析了一项针对晚期HF患者的整群随机对照试验的数据，这些患者主要为射血分数降低。主要结局是通过接受者操作特征（ROC）曲线分析评估SHFM、由HF心脏病专家回答的SQ（“如果该患者在1年内死亡，你会感到意外吗？”）以及NoH的预后辨别能力。使用约登指数计算最佳截断值（SHFM：预测1年生存率<86%；NoH≥2）。
535名受试者中，82名（15.3%）在随访1年后死亡。SHFM、SQ和NoH在ROC曲线下面积相似[SHFM：0.65（0.60 - 0.71 95%CI）；SQ：0.58（0.54 - 0.63 95%CI）；NoH：0.56（0.50 - 0.62 95%CI）]，敏感性也相似[SHFM：0.76（0.65 - 0.84 95%CI）；SQ：0.84（0.74 - 0.91 95%CI）；NoH：0.56（0.45 - 0.67 95%CI）]。与SHFM相比，SQ的特异性较低[SQ：0.33（0.28 - 0.37 95%CI） vs. SHFM：0.55（0.50 - 0.60 95%CI）]，而NoH的特异性相似[0.56（0.51 - 0.61 95%CI）]。SQ与NoH联合使用时特异性显著更高[0.68（0.64 - 0.73 95%CI）]。
对于晚期HF患者的1年生存率预测，SQ和NoH与SHFM具有相当的效用，易于使用且可为床边决策提供依据。
