Work

Development and validation of a prediction model for all-cause death in heart failure patients with preserved ejection fraction: a single-centre cohort study in China

Year: 2025

Type: article

Abstract: OBJECTIVES: To identify risk factors and develop a predictive model for postdischarge all-cause mortality in patients with heart failure with preserved ejection fraction (HFpEF). DESIGN: Retrospective cohort study. SETTING: Tertiary care, Xiangtan Central Hospital, Hunan, China. PARTICIPANTS: 9419 patients with HFpEF, diagnosed between May 2014 and January 2023 according to 2021 European Society of Cardiology criteria (N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥125 pg/mL, left ventricular ejection fraction ≥50%, New York Heart Association (NYHA) class II-IV). Exclusions were age <18 years, pregnancy, malignancy with life expectancy <1 year, dialysis-dependent renal failure, non-cardiac life expectancy <1 year and in-hospital death during index admission. Patients were allocated to a training cohort (n=6935) and a temporal validation cohort (n=2484). PRIMARY OUTCOME MEASURES: All-cause mortality within 3 years of hospital discharge. RESULTS: 10 independent predictors were identified: NT-proBNP, albumin, age, NYHA class III-IV, C reactive protein, right atrial end-systolic diameter, haemoglobin, chronic obstructive pulmonary disease, hyponatraemia and prior percutaneous coronary intervention. The prediction model demonstrated good discrimination, an area under the receiver operating characteristic curve of 0.756 (95% CI 0.743 to 0.769) in the training cohort and 0.764 in the validation cohort. Based on calculated risk scores, patients were classified into low-risk (≤200.36), medium-risk (200.37-232.24) and high-risk (≥232.25) groups, corresponding to 3-year mortality rates of 12.6%, 40.8% and 68.0%, respectively. CONCLUSIONS: A simple clinical model using routinely available parameters enables effective 3-year mortality risk stratification in HFpEF patients after discharge. External validation is needed to confirm its generalisability. TRIAL REGISTRATION NUMBER: NCT06487468.

Source: BMJ Open

DOI: 10.1136/bmjopen-2024-094909