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A Dynamic Prognosis Model of Patients with Chronic Heart Failure: A Prospective Cohort Study Using Follow-Up Data and
Yujia Zhang1, Mengyi Dou2, Fengqin Ding3
1Clinical Medicine Program, The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, 030001, People's Republic of China.
Background:
Prediction models for mortality risk in patients with chronic heart failure (CHF) have traditionally relied on static admission data, which restricts capturing disease dynamics. Longitudinal follow-up data were used to develop a dynamic model to improve accuracy and provide evidence for tailored interventions.
Methods:
We enrolled 1,333 CHF patients from 3 Shanxi centres. Data included CHF patient-reported outcome (PRO) measures (CHF-PROM), lifestyle, medications, and prognosis. Endpoint: all-cause mortality. Using sequential data, we developed Gated Recurrent Units (GRU), Long Short-Term Memory (LSTM), Multi-layer Perceptron (MLP), and Logistic Regression (LR) for 3-year risk. Performance assessed by area under the receiver operating characteristic curve (AUC), accuracy, true negative rate (TNR), true positive rate (TPR), Brier score, and F1-score. Temporal Shapley Additive exPlanations (TimeSHAP) provided interpretability, and a web tool built.
Results:
Among models tested, the GRU model demonstrated strongest predictive accuracy, with performance steadily increasing as follow-up progressed. By 24 months, the GRU-based model attained its peak predictive performance, yielding an AUC of 0.765 (95% confidence interval [CI]: 0.761-0.768), an F1-score of 0.537 (95% CI: 0.531-0.542), and a Brier score of 0.208 (95% CI: 0.199-0.216). TimeSHAP indicated that physical condition, appetite, sleep, physical independence, and anxiety within the CHF-PROM, together with age and New York Heart Association Functional Classification functional class, were key predictors of 3-year all-cause mortality in patients with CHF.
Conclusion:
PRO data from multiple follow-ups, combined with a model constructed using GRU, provides promising tool for predicting mortality risk in patients with chronic heart failure (CHF). The self-developed web-based decision support system allows users to calculate risk scores simply by entering patient information.
Trial Registration:
Study registered with the China Clinical Trial Registry [identifier: ChiCTR2100043337]. Experimental registration date is February 11, 2021.
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