Abstract 13207: The First Prognostic Model for Stroke and Death in Patients With Systolic Heart Failure
Background-Patients: with systolic heart failure (HF) are at increased risk of both ischemic stroke and death. The Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial studied 2,305 HF patients, in sinus rhythm, followed for up to 6 years (3.5 ± 1.8). This previously published trial showed no overall difference in those treated with warfarin versus aspirin with regard to death or stroke. The current study develops the first prognostic model to identify patients at higher risk of stroke or death based on their overall risk profile. This will help identify patients in need of more intensive monitoring and therapy and may help identify appropriate populations for trials of new therapies.
Methods and Results: The final prognostic model used 8 readily obtainable clinical characteristics as predictors: Age, Gender, Hemoglobin, BUN, ejection fraction, systolic blood pressure, diabetes status and prior stroke or TIA (C-index = 0.65, 95% CI: 0.612-0.679). It was validated internally using a bootstrap method. A scoring algorithm to predict a risk score and the probability of stroke-free survival on the basis of the 8 clinical characteristics was generated. In predicting 1-year survival for death alone, our 8-predictor model had an AUC of 0.64 (95% CI: 0.586-0.688) while the 14-predictor Seattle model had an AUC of 0.72.The Seattle model did not report stroke.
Conclusions: This novel prognostic model predicts the overall risk of ischemic stroke or death for HF patients. It has adequate predictive capacity for death and has the added utility of including stroke as an endpoint. Use of this model will help identify those patients in need of more intensive monitoring and therapy and may help identify appropriate populations for trials of new therapies.
- © 2013 by American Heart Association, Inc.