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Prognostic Utility of the HFpEF-ABA Score for HFpEF Patients: Insights From the TOPCAT Trial
Wengen Zhu1, Linjuan Guo2, Xi Chen3
1Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Background:
The HFpEF-ABA score, incorporating age, body mass index (BMI), and atrial fibrillation (AF), has demonstrated utility in patients with heart failure with preserved ejection fraction (HFpEF).
Objectives:
This study evaluated the prognostic performance of the HFpEF-ABA score within the Americas and Russia/Georgia cohorts of the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, examining its association with clinical outcomes across these distinct regions.
Methods:
Cox proportional hazards and competing risk regression analyses assessed associations between HFpEF-ABA probabilities and clinical outcomes.
Results:
Among the Americas cohort (n = 1,726), 72.7% exhibited an HFpEF-ABA probability ≥75%. Elevated HFpEF-ABA probabilities were modestly associated with an increased risk of HF hospitalization HR per 10% increase: 1.07; 95% CI: 1.00-1.14) and any hospitalization (HR per 10% increase: 1.04; 95% CI: 1.00-1.08), without significant associations with mortality or major cardiovascular events. In the Russia/Georgia cohort (n = 1,674), 39.8% had probability ≥75%. Higher HFpEF-ABA probabilities were significantly associated with increased risks of all-cause mortality (HR: 1.67; 95% CI: 1.16-2.41), heart failure hospitalization (HR: 1.98; 95% CI: 1.04-3.78), any hospitalization (HR: 1.75; 95% CI: 1.43-2.14,) and stroke (HR: 2.81; 95% CI: 1.44-5.5). A linear trend of escalating adverse outcome risks corresponded with increasing HFpEF-ABA probabilities in the Russia/Georgia cohort, excluding stroke.
Conclusions:
Our study demonstrates substantial regional heterogeneity in the prognostic utility of the HFpEF-ABA score among patients with HFpEF enrolled in the TOPCAT trial. The score exhibited strong associations with adverse outcomes in the Russia/Georgia cohort, whereas its prognostic discrimination was attenuated in the Americas cohort. (Aldosterone Antagonist Therapy for Adults With Heart Failure and Preserved Systolic Function [TOPCAT]; NCT00094302).
