Prediction models and risk scores in different types of heart failure: a review

Heart failure (HF) is a leading cause of global disease burden and mortality. Accurate prognosis assessment is critical for reducing the risk of adverse events. In recent years, numerous predictive models have been developed for different HF subtypes. However, the quality of existing models varies considerably, and there remains a lack of consensus on models suitable for widespread clinical application. This study systematically reviews the current landscape of HF prediction models, analyzes their strengths and limitations, and provides guidance for future research.

This review systematically retrieved studies on prognostic prediction models for HF from databases including PubMed and Embase, with a search period spanning from the inception of each database to 19 September 2025. The risk of bias of the included studies was assessed using the prediction model risk of bias assessment tool, and the performance of the prediction models was evaluated through metrics such as the C-index and calibration.

A total of 46 prediction models from 38 studies were included. According to target population classification, 14 models were developed for predicting outcomes in HF patients with reduced ejection fraction, nine models were applicable to HF patients with preserved ejection fraction, one model targeted HF patients with mildly reduced ejection fraction, and the remaining 22 were designed for all HF patients regardless of subtype. The risk of bias assessment showed that 10 models had a high risk of bias, 21 models demonstrated an unclear risk of bias, and 15 models exhibited a low risk of bias. The study systematically summarized each model's study cohort, modeling methodology, predictors, outcomes, prediction performance, presentation format, as well as strengths and limitations.

Refining the methodological processes of model construction-including optimizing study cohort selection, updating predictor screening (such as incorporating novel biomarkers, imaging indicators, and multi-omics data), improving modeling strategies, and enhancing model presentation-will contribute to the development of more accurate and clinically applicable prediction models. Such advancements hold significant potential for improving clinical outcomes in patients across all types of HF. This review provides a substantive reference for future research in this field.