Risk scores for predicting incident heart failure admission in patients with chronic coronary syndromes: validation in a prospective, monocentric, long-term, cohort study
Authors: Ruiz Ortiz M , Sanchez Fernandez J , Ogayar Luque C , Romo Penas E , Delgado Ortega M , Lopez Aguilera J , Carrasco Avalos F , Castillo Dominguez J.C , Anguita Sanchez M , Rodriguez Almodovar A , Esteban Martinez F , Mesa Rubio D , Lopez Granados A , Arizon Del Prado J.M , Pan Alvarez-Ossorio M 
Published: October 2021

Abstract

Background
Heart failure (HF) admission is a serious event in the follow up of patients with chronic coronary syndromes (CCS). Stratification schemes have been described for predicting this end-point but none of them has been externally validated.

Purpose
To develop point-scores for predicting incident HF admission with data from previous studies, to perform an external validation in an independent prospective cohort study, and to compare their discriminative ability for this event.

Methods
We performed a literature review searching for prospective studies including patients with CCS, excluding patients with HF at baseline, with data on HF admission incidence in follow up and predictive variables. If undescribed previously, scores were developed including those variables independently associated with this outcome, and score points were assigned based in the relative magnitude of the coefficients of Cox regression models. The resulting scores were validated and their discriminative ability compared in a prospective, monocentric, 17-years cohort study, that included consecutive outpatients with CCS.

Results
Four studies were included: two post-hoc analysis of clinical trials (CARE and PEACE) and two observational registries (CORONOR and CLARIFY). The validation cohort included 1212 patients (mean age 67±11 years, 74% male) followed for up to 17 years (median 12 years, p25–75 5–15 years), with 171 patients suffering at least one HF admission in follow-up. The proportions of the variables needed for scores calculation available in the database of the study were 75% (6/8), 88% (15/17), 100% (8/8) and 85% (17/20) respectively, for each of these study-derived scores. Discriminative ability for predicting HF admission was statistically significant for all (C-statistic 0.72, 95% CI 0.68–0.75, p&lt;0.0005; 0.72, 95% CI 0.68–0.76, p&lt;0.0005; 0.73, 95% CI 0.69–0.76, p&lt;0.0005; and 0.69, 95% CI 0.65–0.73, p&lt;0.0005 for CARE, PEACE, CORONOR and CLARIFY scores, figure 1) and paired comparison among them were all non-significant except for CORONOR and CLARIFY scores (p=0.03). The CORONOR score (Age [each year] 2 points, ejection fraction [each percentage point] −1 point, hypertension 11 points, diabetes 10 points, atrial fibrillation 14 points, body mass index [each kg/m2 unit] 1 point, symptomatic angina 11 points and multivessel disease 7 points) identified subgroups of patients with 12 years-HF admission free survival probabilities of 97%, 87 and 62% (p&lt;0.0005, first, second and third tertile of the score, figure 2).

Conclusions
All tested scores showed significant discriminative ability for predicting incident HF admission in this independent validation study. Their discriminative ability was similar, except that CORONOR score performed significantly better than CLARIFY score.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The work for this paper was funded by the Andalusian Society of Cardiology through anunconditional grant from Astra Zeneca. ROC curves for HF predictive scoresHF free survival by CORONOR score