Mortality Risk Prediction Dynamics After Heart Failure Treatment Optimization: Repeat Risk Assessment Using Online Risk Calculators.

Objectives: Heart failure (HF) management has significantly improved over the past two decades, leading to better survival. This study aimed to assess changes in predicted mortality risk after 12 months of management in a multidisciplinary HF clinic.
Materials and Methods: Out of 1,032 consecutive HF outpatients admitted from March-2012 to November-2018, 357 completed the 12-months follow-up and had N-terminal pro-B-type natriuretic peptide (NTproBNP), high sensitivity troponin T (hs-TnT), and interleukin-1 receptor-like-1 (known as ST2) measurements available both at baseline and follow-up. Three contemporary risk scores were used: MAGGIC-HF, Seattle HF Model (SHFM), and the Barcelona Bio-HF (BCN Bio-HF) calculator, which incorporates the three above mentioned biomarkers. The predicted risk of all-cause death at 1 and 3 years was calculated at baseline and re-evaluated after 12 months.
Results: A significant decline in predicted 1-and 3-year mortality risk was observed at 12 months: MAGGIC ~16%, SHFM ~22% and BCN Bio-HF ~15%. In the HF with reduced ejection fraction (HFrEF) subgroup guideline-directed medical therapy led to a complete normalization of left ventricular ejection fraction (≥50%) in almost a third of the patients and to a partial normalization (41-49%) in 30% of them. Repeated risk assessment after 12 months with SHFM and BCN Bio-HF provided adequate discrimination for all-cause 3-year mortality (C-Index: MAGGIC-HF 0.762, SHFM 0.781 and BCN Bio-HF 0.791).
Conclusion: Mortality risk declines in patients with HF managed for 12 months in a multidisciplinary HF clinic. Repeating the mortality risk assessment after optimizing the HF treatment is recommended, particularly in the HFrEF subgroup.
Competing Interests: AB-G has received lecture honoraria from Abbott, AstraZeneca, Boehringer-Ingelheim, Novartis, Vifor, Roche Diagnostics, and Critical Diagnostics. AB-G and JL report a relationship with Critical Diagnostics. WL—steering committee for Respircardia and Cardiac Dimensions, clinical event committees for Abbott, EBR Systems, Beckman Coulter NTproBNP, and Siemens NTproBNP. He has grant support from Medtronic. He is a consultant to Medtronic and Impulse Dynamics. University of Washington CoMotion holds the copyright to the SHFM. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Codina, Zamora, Levy, Revuelta-López, Borrellas, Spitaleri, Cediel, Ruiz-Cueto, Cañedo, Santiago-Vacas, Domingo, Buchaca, Subirana, Santesmases, Espriella, Nuñez, Lupón and Bayes-Genis.)