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The MUSIC Risk score: a simple method for predicting mortality in ambulatory patients with chronic heart failure
Rafael Vazquez1, Antoni Bayes-Genis, Iwona Cygankiewicz
1Cardiology Service, Valme University Hospital, Carretera a Cadiz s/n, 41014 Seville, Spain. plan@telefonica.net
Insights
This study developed prognostic models for chronic heart failure (CHF) patients. A new MUSIC Risk score effectively predicts cardiac mortality, identifying high-risk individuals for closer management.
Area of Science:
- Cardiology
- Clinical Medicine
- Biostatistics
Background:
- Prognosis in chronic heart failure (CHF) is highly variable and generally poor.
- Accurate prognostic models are crucial for managing CHF patients.
Purpose of the Study:
- To develop and validate prognostic models for predicting mortality in CHF patients.
- To identify key predictors of all-cause mortality, cardiac mortality, pump-failure death, and sudden death.
Main Methods:
- Prospective follow-up of 992 ambulatory CHF patients for a median of 44 months.
- Development of multivariable Cox models to predict different mortality endpoints.
- Calculation of MUSIC Risk scores based on identified predictors.
Main Results:
- Ten independent predictors were identified: prior atherosclerotic vascular event, left atrial size, ejection fraction, atrial fibrillation, conduction delays, ventricular arrhythmias, estimated glomerular filtration rate, hyponatremia, NT-proBNP, and troponin status.
- A MUSIC Risk score >20 identified a high-risk subgroup with a four-fold increased cardiac mortality risk.
- Models successfully predicted all-cause mortality (n=267), cardiac mortality (n=213), pump-failure death (n=123), and sudden death (n=90).
Conclusions:
- A simple, non-invasive risk score effectively predicts cardiac mortality in CHF patients.
- The MUSIC Risk score can identify high-risk individuals requiring close clinical management.
- This tool aids in stratifying risk and optimizing care for chronic heart failure.
Aims:
The prognosis of chronic heart failure (CHF) is extremely variable, although generally poor. The purpose of this study was to develop prognostic models for CHF patients.
Methods And Results:
A cohort of 992 consecutive ambulatory CHF patients was prospectively followed for a median of 44 months. Multivariable Cox models were developed to predict all-cause mortality (n = 267), cardiac mortality (primary end-point, n = 213), pump-failure death (n = 123), and sudden death (n = 90). The four final models included several combinations of the same 10 independent predictors: prior atherosclerotic vascular event, left atrial size >26 mm/m(2), ejection fraction < or =35%, atrial fibrillation, left bundle-branch block or intraventricular conduction delay, non-sustained ventricular tachycardia and frequent ventricular premature beats, estimated glomerular filtration rate <60 mL/min/1.73 m(2), hyponatremia < or =138 mEq/L, NT-proBNP >1.000 ng/L, and troponin-positive. On the basis of Cox models, the MUSIC Risk scores were calculated. A cardiac mortality score >20 points identified a high-risk subgroup with a four-fold cardiac mortality risk.
Conclusion:
A simple score with a limited number of non-invasive variables successfully predicted cardiac mortality in a real-life cohort of CHF patients. The use of this model in clinical practice identifies a subgroup of high-risk patients that should be closely managed.
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