MAGGIC Score and Seattle Heart Failure Model are Less Reliable in Heart Failure with Preserved Ejection Fraction and Nonischemic Cardiomyopathy

Abstract

Introduction: We studied the performance of MAGGIC score and Seattle Heart failure Model (SHFM) in predicting 1-year mortality (1YM) among patients enrolled in a CHF clinic. Methods: Patients enrolled in the CHF clinic at least 1 year prior to the study were included for analysis (n = 134). Predicted 1YM calculated using MAGGIC and SHFM was compared to observed 1YM (death within 1 year of clinic enrolment). Results: 100 patients had EF < 50% (HFr+mrEF) and 34 had EF ≥ 50% (HFpEF). 74 patients had ischemic cardiomyopathy (ICM) and 60 had nonischemic cardiomyopathy (NICM). 35 patients died within 1 year of enrolment. The overall observed 1YM (26%) was slightly higher than 1YM predicted by MAGGIC (23%) and SHFM (23%). In HFpEF the observed 1YM was significantly higher (38%) than predicted by MAGGIC (20%) and SHFM (24%). Binomial logistic regression (Wald χ2) showed significant correlation between predicted and observed 1YM in the entire cohort, HFr+mrEF and ICM but not in HFpEF or NICM (fig. 1). Predicted 1YM was higher among dead patients in the entire cohort (MAGGIC: 29% vs. 21%, P = .005; SHFM: 28% vs. 21%, P = .045) as well as patients with HFr+mrEF and ICM (Fig. 2, Fig. 3). On the contrary in HFpEF and NICM predicted 1YM was similar among patients dead or alive at 1 year (Fig. 2, Fig. 3). Discussion: Both MAGGIC and SHFM significantly underestimated 1-year mortality in HFpEF by 47% and 36% respectively. In HFpEF and NICM, the predicted 1YM for an individual patient did not correlate well with the observed 1YM. Also the predicted 1YM among dead patients was similar to patients alive at 1 year in HFpEF and NICM. This affects the reliability of MAGGIC or SHFM in predicting 1 year mortality in patients with HFpEF or NICM. Conclusion MAGGIC and SHFM are less reliable for predicting 1 year mortality in HFpEF and NICM compared to HFr+mrEF and ICM.Fig. 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3View Large Image Figure ViewerDownload Hi-res image Download (PPT)