1. Modes of death and prognostic outliers in chronic heart failure
- Author
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Andrea Passantino, Valentina Milani, Gian Luigi Nicolosi, Roberto Latini, Aldo Pietro Maggioni, Francesca Olmetti, Nina Ajmone Marsan, Maria Teresa La Rovere, Rosa Raimondo, Ugo Corrà, Domenico Scrutinio, LUIGI TAVAZZI, Pietro Ameri, and Laura Scelsi
- Subjects
Male ,medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Risk Assessment ,Sudden cardiac death ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Cause of Death ,medicine ,Humans ,030212 general & internal medicine ,education ,Cause of death ,Aged ,Probability ,Heart Failure ,education.field_of_study ,Framingham Risk Score ,Ejection fraction ,business.industry ,Incidence (epidemiology) ,Incidence ,Stroke Volume ,medicine.disease ,Prognosis ,Death, Sudden, Cardiac ,Heart failure ,Area Under Curve ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment - Abstract
The impact of incident sudden cardiac death (SCD) on the predictive accuracy of prognostic risk scores for patients with chronic heart failure (HF) has rarely been examined. We assessed the relationship between estimated probability of death and modes of death in this population, as well as the predictors of death and survival in prognostic outliers.The MAGGIC 3-year probability of death was estimated in 6,859 participants of the GISSI-HF trial (mean age 67±11 years, 78% men, 91% with ejection fraction40%, mean follow-up 3.5±1.3 years, observed mortality 28.4%). The incidence of SCD progressively decreased with increased probability of death, and occurred in 52.5% of patients estimated at low-risk (N = 61 with probability14%) vs. in 23.5% of the high-risk ones (N = 375 with probability56%, P.0001). On the contrary, death from worsening HF was significantly more frequent in the latter group (19.7% vs. 46.1%, P.0001). The overall predictive accuracy of the MAGGIC model improved after excluding deaths from SCD (AUC from 0.731 to 0.760, P = .0034). Among patients estimated at low-risk (N = 61 dead, 743 alive), independent predictors of death were older age, longer history of HF, higher serum uric acid and chronic obstructive pulmonary disease. The only predictor of survival in patients estimated at high-risk (N = 210 alive, 375 dead) was higher systolic blood pressure.The MAGGIC risk score demonstrated its scarce ability to capture SCD, particularly in chronic HF patients estimated at low risk of death. Newer and better prognostic tools in the evolving horizon of HF are needed.
- Published
- 2018