Prediction of incident heart failure in established atherosclerotic cardiovascular disease: the SMART2-HF model
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: Patients with established atherosclerotic cardiovascular disease (ASCVD) are at high risk of developing heart failure (HF). However, incident HF is not part of the risk assessment of current guideline-recommended models. The aim of this study was to develop and externally validate the SMART2-HF model for prediction of incident HF in patients with ASCVD. METHODS: SMART2-HF was developed in 7698 individuals with established ASCVD (coronary, cerebrovascular, or peripheral artery disease, or abdominal aortic aneurysm) but without prior HF from the UCC-SMART cohort. Cox proportional hazards models including sex-predictor interactions and with age as the time scale were derived to estimate the 10-year and lifetime risk of incident HF (hospitalization for HF or HF-related death), accounting for competing non-HF mortality. Predictors, limited to routinely available clinical characteristics, were aligned with the SMART2 risk model for recurrent cardiovascular (CV) risk in the same population. External validation was performed in 240 741 patients with ASCVD from six data sources: the Clinical Practice Research Datalink, the HUNT3 study, the SWEDEHEART Registry, the ASCVD-Particles cohort, the Estonian Biobank and the international REACH Registry. RESULTS: During a median follow-up of 11.2 years (interquartile range 6.1-16.4 years), 1031 incident HF events (13%) occurred in the UCC-SMART cohort. In the external validation data sources, a total of 24 885 incident HF events (10%) occurred. The pooled C-statistic was .696 (95% confidence interval .674-.717), with consistent performance in subgroups by sex and type of ASCVD. Predicted risks matched observed incidence in external validation. CONCLUSIONS: The SMART2-HF model enables the prediction of incident HF in patients with ASCVD. Aligned with the guideline-recommended SMART2 model for recurrent CV risk, SMART2-HF can be used as a complementary tool in this population.
Source: European Heart Journal
Authors: Tessa H Reitsma, Carl-Emil Lim, Mari N Gynnild, Stephen Kaptoge, Laura Lõo, Joris Holtrop, Łukasz Kuźma, Lisa Pennells, Nathalie Conrad, Peter Ueda, Tomas Jernberg, Anna Kurasz, Spencer J Keene, Chimweta Chilala, Salil V Deo, Taavi Tillmann, Kamlesh Khunti, Massimo Piepoli, Xavier Rossello, Gianluigi Savarese, Håvard Dalen, Ph Gabriel Steg, Angela M Wood, Jennifer S Lees, Maryam Kavousi, John William McEvoy, Rudolf A de Boer, Charlotte Andersson, Deepak L Bhatt, Frank L J Visseren, Jannick A N Dorresteijn, Stefan Koudstaal, Emanuele Di Angelantonio, Steven H J Hageman, S I M Bongers, J L P van Giele, M Van Daal, M J Cramer, M G van der Meer, P van der Harst, H M Nathoe, J van Setten, M Teraa, N C Onland-Moret, M van Smeden, M H Emmelot-Vonk, P A de Jong, A T Lely, S Haitjema, M M Mokhles, Y M Ruigrok, M C Verhaar, J A N Dorresteijn, F L J Visseren
Institutions: University Medical Center Utrecht, Karolinska Institutet, University of Oslo, Norwegian University of Science and Technology, St Olav's University Hospital, University of Cambridge, British Heart Foundation, University of Tartu, Medical University of Białystok, University of Liverpool, National Medical Institute of the Ministry of Interior and Administration, University of Oxford, KU Leuven, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, University of Glasgow, University of Leicester, Leicester General Hospital, University of Milan, IRCCS Policlinico San Donato, Health Research Institute of the Balearic Islands, Hospital Universitario Son Espases, Universitat de les Illes Balears, Stockholm South General Hospital, Levanger Hospital, Helse Nord-Trøndelag HF, Inserm, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Laboratoire de Recherche Vasculaire Translationnelle, Hôpital Bichat-Claude-Bernard, National Institute for Health and Care Research, Health Data Research UK, Erasmus MC, Ollscoil na Gaillimhe – University of Galway, Brigham and Women's Hospital, Harvard University, Herlev Hospital, Copenhagen University Hospital, Gentofte Hospital, Icahn School of Medicine at Mount Sinai, Human Technopole
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,922
Funders: Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, AstraZeneca, Sanofi, Alnylam Pharmaceuticals, Norges Teknisk-Naturvitenskapelige Universitet, Wellcome Trust, Scottish Government, National Institute for Health and Care Research, British Heart Foundation, Department of Health and Social Care, Public Health Agency, University of Galway, Universiteit Utrecht, Daiichi-Sankyo, KU Leuven, Novo Nordisk, Helse Midt-Norge, Servier, Idorsia Pharmaceuticals, Chief Scientist Office, Scottish Government Health and Social Care Directorate, HORIZON EUROPE Framework Programme, Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division, NIHR Cambridge Biomedical Research Centre, Faculty of Medicine and Health, University of Sydney, Norwegian Institute of Public Health
OpenAlex ID: W7134977601