Performance of the MAGGIC Score in Individuals with Heart Failure: Validation in a Brazilian Population

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain.

To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort.

This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant.

The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236).

The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients.