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Prediction of individual lifetime risk in Portuguese patients with HFrEF
Session:
Sessão de Posters 18 - Insuficiência cardíaca - Fatores preditores
Speaker:
Margarida G. Figueiredo
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Margarida G. Figueiredo; Pedro Freitas; Mariana Paiva; Gonçalo Cunha; Bruno Rocha; Pedro Lopes; Francisco Gama; Cláudia Silva; Sara Guerreiro; João Abecasis; António Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri","sans-serif"">Many prediction models exist for patients with HF with reduced ejection fraction (HFrEF), estimating the 1 to 5-year risk of hospitalisation and mortality; however, few models are available to predict individual lifetime risk and treatment benefit. A recent model has been developed to close this gap in patients with HFrEF – the LIFEtime-perspective for Heart Failure (LIFE-HF) model. Purpose: We aimed to validate this model in a cohort of HFrEF patients who underwent cardiac magnetic resonance (CMR). Methods: Patients with known HFrEF who underwent CMR for clinical reasons between 2017 and 2019 were included. Using the interactive online LIFE-HF calculator, we estimated each patient’s 2-year risk of all-cause mortality or HF hospitalisation at baseline (before performing the CMR). Then, the 2-year risk was recalculated according to therapy modifications made by the attending Cardiologist after reading the CMR report. Finally, the 2-year predicted risk of HF hospitalisation and all-cause mortality on optimal guideline-recommended pharmacological therapy was calculated. The primary endpoint was HF hospitalisation and all-cause mortality at 2 years. Results:<strong> </strong>A total of 161 patients<strong> </strong>were analysed; mean age was 66 ± 10 years and 75% of patients were male. Ischemic aetiology of heart failure was present in<span style="background-color:white"> 70% of cases.</span> Most of the patients (82.6%) were in NYHA class I or II, and the median NT-ProBNP was 1103 (IQR 337 - 3013) pg/mL. Before CMR, 92.5% of patients were on β-blockers, 70.8% on ACEi/ARB, 19.9% on ARNI, 50.3% on MRA and 6.8% on SGLT2i. The median LVEF at CMR was 32% (range 24-39%). After knowing CMR results, attending Cardiologists decided to uptitrate or modify medical therapy in <span style="background-color:white">almost 50% </span>of patients, with 2.5% of patients starting β-blockers, 6.8% sacubitril/valsartan, 5.0% MRA and 6.2% SGLT2i. Regarding devices, 13.0% received CRT and 32.9% an ICD. All patients had a complete 2-year follow-up. During this period, there were 25 events (21 HF hospitalizations and 4 deaths). The LIFE-HF model presented good discriminative ability, with an AUC of 0.77 (95% CI: 0.67 – 0.86, p < 0.001). Risk was consistently overestimated (calibration-in-the-large: -20%, p<0.05) whether the 2-year risk of HF hospitalisation or all-cause mortality was calculated at baseline or after therapeutic optimization – figure. Conclusions:<strong> </strong>The LIFE-HF model to predict the 2-year risk of all-cause mortality or HF hospitalisation was validated in a Portuguese cohort of HFrEF patients. While providing good discriminative capacity, the LIFE-HF model tended to overestimate the risk of events.</span></span></p>
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