P4152Implications of the ACC/AHA risk score for heart failure risk prediction and its comparison with existing heart failure risk prediction models: A prospective population-based cohort study

Abstract

Abstract Background In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) developed a score for assessment of cardiovascular risk. Due to between study variability in ascertainment and adjudication of heart failure (HF), incident HF was not included as an endpoint in the ACC/AHA risk score. Purpose To assess the performance of the ACC/AHA risk score for HF risk prediction in a large population-based cohort and to compare its performance with the existing HF risk prediction models including the Atherosclerosis Risk in Communities (ARIC) model and the Health Aging and Body Composition (Health ABC) model. Methods The study included 2743 men and 3646 women from a prospective population-based cohort study. Cox proportional hazards models were fitted using risk factors applied by the ACC/AHA model for cardiovascular risk, the ARIC model and the Health ABC model. Independent relationship of each predictor with 10-year HF incidence was estimated in men and women. Next, N-terminal pro-b-type natriuretic peptide (NT-pro-BNP) was added to the ACC/AHA model. The performance of all fitted models was evaluated and compared in terms of discrimination, calibration and the Akaike Information Criterion (AIC). In addition, area under the receiver operator characteristic curve (AUC), sensitivity and specificity of each model in predicting 10-year incident of HF was assessed. The incremental value of NT-pro-BNP to the ACC/AHA model, was assessed using the continuous net reclassification improvement index (NRI). Results During a median follow-up of 13 years (63127 person-years), 387 HF events in women and 259 in men were recorded. The Optimism-corrected c-statistic for ACC/AHA model was 0.76 (95% confidence interval (CI): 0.73–0.79) for men and 0.76 (95% CI: 0.74–0.79) for women. The ARIC model provided the largest c-statistic for both men [0.82 (95% CI: 0.80–0.84)] and women [95% CI: 0.81 (0.79–0.83)] among the three models. Calibration of the models was reasonable. Addition of NT-pro-BNP to the ACC/AHA model considerably improved model fitness for men and for women. The AIC improved from 3104.62 to 2976.28 among men and from 5161.63 to 4921.51 among women. The c-statistic also improved to 0.81 (0.78–0.84) in men and 0.79 (0.77–0.81) in women. The continuous NRI for the addition of NT-pro-BNP to the base model was 5.3% (95% CI: −12.3–28.6%) for men and 15.9% (95% CI: 2.7–24.7%) for women. Conclusions Compared to HF-specific models, the ACC/AHA model, containing routine clinically available risk factors, had a reasonable performance in prediction of HF risk. Inclusion of NT-pro-BNP in the ACC/AHA model strongly increased the model performance. To achieve a better model performance for 10-year prediction of incident HF, updating the simple ACC/AHA risk score with the addition of NT-pro-BNP is recommended.