Simplified cardiac risk score may help predict heart failure in primary care

A simplified cardiac risk score may help predict heart failure in primary care, a new study indicates.

Researchers used data from the Atherosclerosis Risk in Communities (ARIC) Study cohort to test the validity and accuracy of existing heart failure risk scores, including the Framingham Heart Study score and the Health ABC score. They also derived a new, “parsimonious” score focusing on primary care, the ARIC HF risk score, and compared it with the other scores in prediction of 10-year heart failure risk. The value of biomarkers in predicting long-term risk was also evaluated. The study results were published online May 15 by Circulation: Heart Failure.

Over 15.5 years and 210,102 person-years of follow-up, 13,555 members in the ARIC Study cohort had 1,487 heart failure events. The area under the curve for the Framingham, Health ABC, and ARIC risk scores as derived in the ARIC cohort were 0.762, 0.783 and 0.797, respectively. Adding N-terminal pro-B-type natriuretic peptide (NT-proBNP) to the scores improved the overall classification by 18%, 12% and 13%, respectively. However, adding cystatin C or high-sensitivity C-reactive protein to the models did not improve risk prediction.

The authors noted that heart failure outcomes might not have been classified correctly in all cases and that few echocardiography data were available. However, they determined that the ARIC risk score is slightly better at predicting 10-year risk for heart failure than existing risk scores in the community setting, and that including NT-proBNP substantially improves risk prediction. In addition, a risk score that included fewer variables—the patient's age, race, gender, and NT-proBNP values—was as effective as the full score.

Further replication and calibration of their results are likely needed, the authors said. The risk calculators used in the study are available online.