The Barcelona Bio-Heart Failure risk calculator may predict 1-year mortality in patients with advanced heart failure

Accurate risk assessment in patients with heart failure (HF) is crucial. Developing new models that combine biochemical and clinical variables with novel biomarkers is the best approach to improving the management and prognostic evaluation in this population.

We aimed to assess and compare the predictive utility of a new prognostic scale, the Barcelona Bio‑Heart Failure (BCN Bio‑HF) risk calculator, as well as traditional risk scores, the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM), in patients with end‑stage HF. We also searched for other risk factors associated with worse prognosis in the analyzed population.

This was a prospective analysis of 279 patients with end‑stage HF listed for heart transplant between 2018 and 2021. The BCN Bio‑HF, HFSS, and SHFM scores were calculated in all patients, and the accuracy of these 3 models for predicting 1‑year mortality was assessed using receiver operating characteristic (ROC) analysis.

Median (interquartile range) age of the patients was 56 (50-60) years, and 87.1% of the study population were men. During 1‑year follow‑up, a total of 95 patients (34.1%) died. The areas under the ROC curves for predicting 1‑year mortality were 0.95 (95% CI, 0.92-0.97) for BCN Bio‑HF, 0.81 (95% CI, 0.76-0.86) for HFSS, and 0.7 (95% CI, 0.63-0.76) for SHFM. We found that the BCN Bio‑HF (hazard ratio [HR], 1.015; 95% CI, 1.012-1.019; P <0.001) and HFSS scores (HR, 2.801; 95% CI, 1.848-4.237; P <0.001), along with the circulating bilirubin concentration (HR, 1.015; 95% CI, 1.002-1.028; P = 0.02), were associated with 1‑year mortality in the analyzed population.

The BCN Bio‑HF risk score had significantly better prognostic performance than HFSS or SHFM. Lower BCN and HFSS scores and a higher bilirubin concentration were independently associated with a higher risk of 1‑year death in patients with end‑stage HF.