Performance of Prognostic Risk Scores in Elderly Chinese Patients with Heart Failure

Figures & data

Figure 1 Patient flowchart of this study.

Table 1 Baseline Characteristics of Elderly Patients with Heart Failure by Status at 1-Year Follow-Up

	Age ≥ 70 Years	Alive at 1-Year	Dead at 1-Year	P value	SHFM	MAGGIC
	(N=675; 100%)	(N=601; 89%)	(N=74; 11%)
Characteristics
Age, years	80.0±5.1	79.3±5.0	81.4±5.6	0.001	√	√
Male, %	50.8	50.6	52.7	0.73	√	√
Weight, kg	66.5±12.7	66.9±12.5	63.1±13.8	0.02	√
BMI, kg/m^2	25.0±3.9	25.0±4.2	23.3±4.5	0.002		√
Systolic BP, mmHg	136.5±21.8	134.6±20.9	136.8±21.9	0.41	√	√
HF history>18 months, %	28.1	27.6	32.4	0.39		√
Ischemic etiology, %	68.3	68.4	67.6	0.89	√
Comorbidities, %
AMI	10.8	9.3	23.0	<0.001
AF	51.1	50.8	54.1	0.59
DM	39.6	40.6	31.1	0.11		√
COPD	9.2	8.5	14.9	0.07		√
Current smokers	8.2	7.9	10.8	0.37		√
ICD/CRT, %	5.6	6.2	1.4	0.11	√
NYHA functional class, %				0.007	√	√
I	1.9	2.0	1.3
II	32.4	33.0	28.4
III	50.8	52.0	41.9
VI	14.8	13.1	28.4
Lab results
Hemoglobin, g/L	119.3±20.8	120.2±20.9	112.0±18.7	0.001	√
Lymphocyte, %	23.4±9.4	24.1±9.2	18.3±9.3	<0.001	√
Sodium, mmol/L	139.5±4.2	139.6±4.0	138.1±5.7	0.004	√
Total cholesterol, mmol/L	3.7±0.9	3.7±0.9	3.6±1.0	0.46	√
Uric acid, mmol/L	398.4±131.3	395.7±129.7	420.6±142.7	0.12	√
Serum creatinine, umol/L	104.8±60.9	101.3±54.3	133.6±95.5	<0.001		√
eGFR, mL/min/1.73m^2	38.7±18.1	39.5±18.1	31.9±2.1	<0.001
Preserved LVEF (≥50%)	61.5	63.2	47.3	0.008	√	√
BBB (LBBB or QRS duration>120ms), %	14.2	14.3	13.5	0.85	√
Medication, %
ACEI/ARB	64.1	66.2	47.3	0.001	√	√
Beta-blockers	76.9	77.0	75.7	0.79	√	√
Spironolactone	62.2	62.4	60.8	0.79	√
Statins	77.9	78.5	73.0	0.28	√
Diuretic	92.2	92.2	92.0	0.93	√
Allopurinol	9.6	8.7	17.6	0.01	√
Predicted 1-year mortality
SHFM, %	8.0(4.0, 13.0)	7.0(4.0, 12.0)	13.0(8.0, 21.8)	<0.001
MAGGIC, %	17.5(13.4, 24.8)	16.0(12.2, 23.8)	22.7(16.0, 29.8)	<0.001

Notes: Values are mean ± standard deviation, %, or median (interquartile range); Statistical significance (P<0.05) is indicated in bold text; √ Components in the SHFM or MAGGIC risk scores.

Abbreviations: ACE, angiotensin-converting enzyme; AF, atrial fibrillation; AMI, acute myocardial infarction; ARB, angiotensin II receptor blocker; BMI, body mass index; BP, blood pressure; COPD, chronic obstructive pulmonary disease; CRT, cardiac resynchronization therapy; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; HF, heart failure; ICD, implantable cardioverter-defibrillator; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; MAGGIC, Meta-analysis Global Group in Chronic Heart Failure; NYHA, New York Heart Association functional class; SHFM, Seattle Heart Failure Model; TC, total cholesterol.

Figure 2 Kaplan–Meier curves of all-cause mortality stratified by tertiles of the SHFM (A) and MAGGIC (B) scores. The two risk scores were significantly associated with mortality (log-rank P<0.0001 for all survival curves).

Abbreviations: MAGGIC, Meta-analysis Global Group in Chronic Heart Failure; SHFM, Seattle Heart Failure Model.

Figure 3 Receiver operating characteristic curves comparing the areas under the curve of risk scores for 1-year mortality.

Abbreviations: MAGGIC, Meta-analysis Global Group in Chronic Heart Failure; SHFM, Seattle Heart Failure Model.

Table 2 Comparison of C-Statistic of the SHFM versus the MAGGIC Score for 1-Year Mortality in Different Age Groups

	C-Statistic (95% CI)		P value
	SHFM	MAGGIC
All ages	0.75 (0.72–0.78)	0.69 (0.66–0.72)	0.009
Three age categories
≥ 80 years	0.65 (0.61–0.71)	0.60 (0.55–0.66)	0.09
70–80 years	0.76 (0.72–0.81)	0.70 (0.65–0.75)	0.2
<70 years	0.79 (0.74–0.83)	0.76 (0.71–0.81)	0.62

Note: Statistical significance (P<0.05) is indicated in bold text.

Abbreviations: ACE, angiotensin-converting enzyme; AF, atrial fibrillation; AMI, acute myocardial infarction; ARB, angiotensin II receptor blocker; BMI, body mass index; BP, blood pressure; COPD, chronic obstructive pulmonary disease; CRT, cardiac resynchronization therapy; DM, diabetes mellitus; eGFR, estimated glomerular filtration rate; HF, heart failure; ICD, implantable cardioverter-defibrillator; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; MAGGIC, Meta-analysis Global Group in Chronic Heart Failure; NYHA, New York Heart Association functional class; SHFM, Seattle Heart Failure Model; TC, total cholesterol.

Figure 4 1-year observed probabilities of mortality at different risk deciles in the overall population predicted by (A) the Seattle Heart Failure Model (SHFM) and (B) the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. The diagonal dashed lines represent perfect calibration.

Figure 5 Risk reclassification of the MAGGIC versus SHFM score for 1-year mortality in elderly heart failure patients.

Abbreviations: MAGGIC, Meta-analysis Global Group in Chronic Heart Failure; SHFM, Seattle Heart Failure Model; NRI, net reclassification improvement.