New HF risk equations may perform better for patients with ASCVD

Novel risk equations can be used to guide decisions on heart failure (HF) screening, prevention, and management in patients with atherosclerotic cardiovascular disease (ASCVD), who have substantially higher risk of incident HF, a recent study found.

For people with known atherosclerotic cardiovascular disease (ASCVD), a tailored, sex-specific risk equation for predicting 10-year risk of heart failure (HF) performed significantly better than equations designed for the general population, a study found.

Researchers developed 10-year HF risk equations using the United Kingdom Biobank (UKB) cohort, including patients who had established ASCVD but no HF at baseline. Model performance was validated using the Australian Baker Heart and Diabetes Institute Biobank (BB) cohort and compared with the performance of general population risk models. Results were published May 23 by the Journal of the American Heart Association.

The UKB cohort was divided into 31,446 participants (6.3%) with ASCVD (median age, 63 years; 35.4% women) and 467,996 participants (93.7%) without ASCVD (median age, 57 years; 55.8% women). Incident heart failure occurred in 4,319 (13.7%) of the ASCVD patients and in 10,506 participants (2.2%) without ASCVD at baseline. The BB cohort was divided into 1,659 participants (29.1%) with ASCVD cohort (median age,65 years; 25.0% women) and 4,044 participants (70.9%) without (median age, 55 years; 43.5% women). Incident HF occurred in 353 participants (21.3%) and in 238 participants (5.9%), respectively.

Predictors of HF included in the new sex-specific models were age, body mass index, systolic blood pressure (treated or untreated), glucose (treated or untreated), cholesterol, smoking status, QRS duration, kidney disease, myocardial infarction, and atrial fibrillation. The equations had good discrimination and calibration in development and validation cohorts, with superior performance to general population risk equations.

The authors added that the equations can be calculated from readily available clinical data and could aid decisions about screening and prevention in a high-risk group. While regular physical activity, smoking cessation, normal weight, and well-controlled blood pressure and glucose are recommended for all patients with ASCVD, applying a high-risk classification for HF might prompt some patients to more closely adhere to these recommendations or introduce medications when ejection fraction is close to threshold, the authors said.

"These equations outperform HF risk equations designed for use in the general population, which underestimate the risk of incident HF in very high-risk individuals," they wrote. "The risk equations can be used to assist in decisions about screening, prevention, and management strategies for HF to avoid or reduce the risk of hospital admission."