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The 3A3B score: The simple risk score for heart failure with preserved ejection fraction - A report from the CHART-2
Shintaro Kasahara1, Yasuhiko Sakata2, Kotaro Nochioka1
1Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Insights
A new risk score, the 3A3B score, effectively predicts long-term mortality in heart failure with preserved ejection fraction (HFpEF) patients using common clinical data.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Heart Failure Research
Background:
- Limited simple risk models exist for heart failure with preserved left ventricular ejection fraction (HFpEF), especially those not requiring echocardiography.
- Accurate prognostication is crucial for managing HFpEF patients.
Purpose of the Study:
- To develop and validate a straightforward risk score for predicting all-cause mortality in patients with HFpEF.
- To identify key prognostic variables for HFpEF patients.
Main Methods:
- Utilized data from 1277 HFpEF patients (LVEF ≥50%, BNP ≥100 pg/ml) in the prospective CHART-2 Study.
- Employed Cox proportional hazard models and random survival forests (RSF) to select optimal prognostic covariates.
- Developed the 3A3B scoring system based on identified variables and validated it in external cohorts (TOPCAT, ASIAN-HF).
Main Results:
- Six key prognostic variables were identified: age ≥75 years, albumin <3.7 g/dl, anemia, BMI <22 kg/m², BUN ≥25 mg/dl, and elevated BNP or NT-proBNP.
- The 3A3B score demonstrated excellent discrimination (c-index 0.708 in CHART-2, 0.652 in TOPCAT, 0.741 in ASIAN-HF).
- The score effectively captured 5-year risk gradients and showed good model fit.
Conclusions:
- A simple, 6-parameter risk score (3A3B score) was developed to predict long-term prognosis in HFpEF.
- The 3A3B score, using readily available clinical parameters, is valuable for risk stratification and management of HFpEF patients.
Background:
Few simple risk models, without echocardiography have been developed for patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) (HFpEF).
Methods:
To develop a risk score to predict all-cause death for HFpEF patients, we examined 1277 HF patients with LVEF ≥50% and BNP ≥100 pg/ml in the CHART-2 Study, a large-scale prospective cohort study for HF in Japan. We selected the optimal subset of covariates for the score with Cox proportional hazard models and random survival forests (RSF).
Results:
During the median 5.7-year follow-up, 576 deaths occurred. Cox models and RSF analyses consistently indicated age ≥75 years, albumin <3.7 g/dl, anemia, BMI <22 kg/m2, BNP ≥300 pg/ml (or NT-proBNP ≥1400 pg/ml), and BUN ≥25 mg/dl, as the important 6 prognostic variables. Incorporating these 6 variables, we developed a scoring system (3A3B score, with 2 points given to age ≥75 years and 1 point to the others based on the hazard ratios. The discrimination ability of the risk score was excellent (c-index 0.708). Regarding model goodness-of-fit, the overall gradient in 5-year risk was well captured by the score. The predictive accuracy of the 3A3B score was confirmed in the external validation cohorts from the TOPCAT trial (N = 835, c-index 0.652) and the ASIAN-HF registry (N = 170, c-index 0.741).
Conclusions:
We developed a simple risk score to predict long-term prognosis of HFpEF patients. The 3A3B score, comprising 6 commonly available parameters in daily practice, has potential utility in the risk stratification and management of HFpEF patients.
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