Highlights
- •To improve our management of HF we need tools to optimize the available resources.
- •The prognostic models help us differentiate the life expectancy of the HF patients.
- •We have externally validated a risk model to predict 1-year mortality.
- •The model was developed and validated in real-world cohorts of HF patients.
Abstract
Aims
To validate externally the CACE-HF clinical prediction rule, which predicts 1-year
mortality in patients with heart failure (HF).
Methods
We performed an external validation of the CACE-HF risk score in patients included
in the RICA heart failure registry who had completed 1 year of follow-up, comparing
the characteristics of the derivation and validation cohorts. The performance of the
risk score was evaluated in terms of calibration, using calibration-in-the-large (a),
calibration slope (b), and the Hosmer-Lemeshow test, and in terms of discrimination,
using the area under the ROC curve.
Results
In total, 3337 patients were included in the validation cohort. There were no significant
differences between the derivation and validation cohorts in 1-year mortality (24.63%
vs. 22.98%) or in the risk score and risk classes. The discrimination capacity in
the validation cohort was slightly lower, 0.67 (95% CI: 0.65, 0.69), compared to that
of the derivation cohort. Calibration results were a −0.05 (95% CI: −0.14, 0.03), indicating that the average predictions did not differ
from the average outcome frequency, and b = 0.75 (95% CI: 0.64, 0.86), indicating a modest inconsistency in predictor effects.
Observed mortality versus predicted mortality according to the deciles and risk classes
were very similar in both cases, indicating good calibration.
Conclusions
The results of the external validation of the CACE-HF risk score show that although
the capacity for discrimination was slightly lower than in the derivation cohort,
the calibration was excellent. This tool, therefore, can assist in decision-making
in the management of these patients.
Keywords
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Article info
Publication history
Published online: June 11, 2019
Accepted:
May 13,
2019
Received in revised form:
May 6,
2019
Received:
December 27,
2018
Identification
Copyright
© 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
