Abstract 17657: The MAGGIC Risk Score: Validation of a Simple Tool for the Prediction of Morbidity and Mortality in Heart Failure With Preserved Ejection Fraction
Background: Heart failure with preserved ejection fraction (HFpEF) is associated with morbidity and mortality rates comparable to HF with reduced EF (HFrEF). Whereas several risk models for HFrEF mortality exist, including the Seattle Heart Failure Model (SHFM), there is a paucity of risk models applicable to HFpEF. We thus sought to validate the recently developed HF mortality risk model from the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC), derived from a large cohort of both HFpEF and HFrEF patients. We hypothesized that the MAGGIC risk score predicts morbidity in addition to mortality and may outperform SHFM in HFpEF.
Methods: We prospectively evaluated the MAGGIC risk score in 420 patients with confirmed, symptomatic HFpEF. We calculated the MAGGIC risk score (comprised of 13 variables, including age, sex, body mass index, systolic blood pressure, ejection fraction, creatinine, current smoker, diabetes mellitus, COPD, NYHA class, HF duration, B-Blocker use, and ACE-I use). We used Cox proportional hazards models and ROC curves to determine the prognostic utility of MAGGIC and SHFM.
Results: There were 59 deaths (14%) and 138 cardiovascular (CV)-related hospitalizations (33%) during a mean follow up time of 15±12 months. The MAGGIC risk score, mean±SD 17±6, was significantly associated with both CV-related hospitalizations and mortality, including the combined endpoint (see Figure): HR 1.8 (95% CI 1.5-2.1, P<0.00001) for each standard deviation increase in the MAGGIC risk score. Predicted 1-year survival was 92% with MAGGIC, 88% with SHFM, and actual 1-year survival was 90%. ROC analysis showed that MAGGIC and SHFM performed equally well for all outcomes (p=NS).
Conclusions: The MAGGIC risk score is a simple yet powerful method of risk stratification for both morbidity and mortality in HFpEF. Based on our results, risk models such as MAGGIC and SHFM have the potential to inform future HFpEF clinical trial design.
- © 2013 by American Heart Association, Inc.