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Open Access 01-08-2021 | Heart Failure | Original Paper

Development and external validation of prognostic models to predict sudden and pump-failure death in patients with HFrEF from PARADIGM-HF and ATMOSPHERE

Authors: Li Shen, Brian L. Claggett, Pardeep S. Jhund, William T. Abraham, Akshay Suvas Desai, Kenneth Dickstein, Jianjian Gong, Lars V. Køber, Marty P. Lefkowitz, Jean L. Rouleau, Victor C. Shi, Karl Swedberg, Michael R. Zile, Scott D. Solomon, John J. V. McMurray

Published in: Clinical Research in Cardiology | Issue 8/2021

Abstract

Background

Sudden death (SD) and pump failure death (PFD) are the two leading causes of death in patients with heart failure and reduced ejection fraction (HFrEF).

Objective

Identifying patients at higher risk for mode-specific death would allow better targeting of individual patients for relevant device and other therapies.

Methods

We developed models in 7156 patients with HFrEF from the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure (PARADIGM-HF) trial, using Fine-Gray regressions counting other deaths as competing risks. The derived models were externally validated in the Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure (ATMOSPHERE) trial.

Results

NYHA class and NT-proBNP were independent predictors for both modes of death. The SD model additionally included male sex, Asian or Black race, prior CABG or PCI, cancer history, MI history, treatment with LCZ696 vs. enalapril, QRS duration and ECG left ventricular hypertrophy. While LVEF, ischemic etiology, systolic blood pressure, HF duration, ECG bundle branch block, and serum albumin, chloride and creatinine were included in the PFD model. Model discrimination was good for SD and excellent for PFD with Harrell’s C of 0.67 and 0.78 after correction for optimism, respectively. The observed and predicted incidences were similar in each quartile of risk scores at 3 years in each model. The performance of both models remained robust in ATMOSPHERE.

Conclusion

We developed and validated models which separately predict SD and PFD in patients with HFrEF. These models may help clinicians and patients consider therapies targeted at these modes of death.

Trial registration number

PARADIGM-HF: ClinicalTrials.gov NCT01035255, ATMOSPHERE: ClinicalTrials.gov NCT00853658.

Graphics abstract

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Title: Development and external validation of prognostic models to predict sudden and pump-failure death in patients with HFrEF from PARADIGM-HF and ATMOSPHERE
Authors: Li Shen
Brian L. Claggett
Pardeep S. Jhund
William T. Abraham
Akshay Suvas Desai
Kenneth Dickstein
Jianjian Gong
Lars V. Køber
Marty P. Lefkowitz
Jean L. Rouleau
Victor C. Shi
Karl Swedberg
Michael R. Zile
Scott D. Solomon
John J. V. McMurray
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Heart Failure
Implantable Cardioverter Defibrillator
Implantable Cardioverter Defibrillator
Published in: Clinical Research in Cardiology / Issue 8/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01888-x

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Development and external validation of prognostic models to predict sudden and pump-failure death in patients with HFrEF from PARADIGM-HF and ATMOSPHERE

Abstract

Background

Objective

Methods

Results

Conclusion

Trial registration number

Graphics abstract

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Abstract

Background

Objective

Methods

Results

Conclusion

Trial registration number

Graphics abstract

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