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Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
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Predicting Survival in Patients With Heart Failure With an Implantable Cardioverter Defibrillator: The Heart Failure

Ana C Alba1, Stephen D Walter2, Gordon H Guyatt2

  • 1Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

Journal of Cardiac Failure
|November 28, 2017
PubMed

Insights

The new HF Meta-score accurately predicts survival in patients with heart failure (HF) and implantable cardioverter-defibrillators (ICDs). This evidence-based model aids in timely management decisions for HF patients.

Area of Science:

  • Cardiology
  • Medical Informatics
  • Public Health

Background:

  • Prognostic evaluation is crucial for managing heart failure (HF) patients, particularly those with implantable cardioverter-defibrillators (ICDs).
  • Accurate prediction of future events guides timely clinical decisions and treatment strategies.
  • Many HF patients receive ICDs, highlighting the need for specific prognostic tools in this population.

Purpose of the Study:

  • To validate a meta-analytically derived prognostic score, the HF Meta-score, for predicting survival in patients with heart failure and ICDs.
  • To compare the performance of the HF Meta-score against existing models like the Seattle Heart Failure Model (SHFM) and SHOCKED predictors.
  • To assess the accuracy and risk classification capabilities of the HF Meta-score in a large cohort of ICD patients.

Main Methods:

  • The HF Meta-score was developed from 14 independent mortality predictors identified in a meta-analysis.
  • Performance evaluation involved a cohort of 9860 ambulatory ICD patients from the Ontario provincial database (2007-2011).
  • The HF Meta-score's calibration, discrimination (c-statistic), and reclassification abilities were compared with SHFM and SHOCKED predictors over a 3-year follow-up period.

Main Results:

  • The HF Meta-score demonstrated excellent calibration and very good discrimination (c-statistic 0.74).
  • It showed enhanced risk classification compared to SHOCKED predictors, improving reclassification by 19% for 1-year survival and 56% for 3-year survival.
  • The performance of the HF Meta-score was comparable to the Seattle Heart Failure Model (SHFM).

Conclusions:

  • The HF Meta-score is an evidence-based model providing accurate prognosis assessment for heart failure patients with ICDs.
  • Its design allows for the integration of new predictors as evidence emerges.
  • This validated score can improve prognostic evaluation and guide management in ICD-HF patients.
Abstract

Keywords:
Heart failureimplantable cardiac defibrillatormortalitypredictive modelprognosis

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