Implications of the ACC/AHA risk score for prediction of heart failure: the Rotterdam Study

• Published in: BMC medicine Vol. 19; no. 1; p. 43
• Main Authors: Arshi, Banafsheh, van den Berge, Jan C, van Dijk, Bart, Deckers, Jaap W, Ikram, M Arfan, Kavousi, Maryam
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16-02-2021; BioMed Central; BMC
• Subjects: Adult; Age; Aged; Antihypertensives; Blood pressure; Cardiology; Cardiovascular disease; Cohort Studies; Confidence intervals; Congestive heart failure; Creatinine; Diabetes; Evaluation; Female; Glucose; Health risks; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - metabolism; Heart Failure - physiopathology; Heart rate; Humans; Hypertension; Male; Medical prognosis; Medical records; Middle Aged; Models, Theoretical; Natriuretic Peptide, Brain - metabolism; Netherlands; NT-proBNP; Peptide Fragments - metabolism; Performance evaluation; Population; Population studies; Practice guidelines (Medicine); Practice Guidelines as Topic; Prediction; Predictions; Prevention; Primary prevention; Primary Prevention - methods; Prognosis; Reclassification; Risk analysis; Risk Assessment - methods; Risk Factors; Statistical analysis; Statistics; Womens health; Netherlands; Heart failure; NT-proBNP; Primary prevention; Prediction
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-021-01916-7

Despite the growing burden of heart failure (HF), there have been no recommendations for use of any of the primary prevention models in the existing guidelines. HF was also not included as an outcome in the American College of Cardiology/American Heart Association (ACC/AHA) risk score.
Among 2743 men and 3646 women aged ≥ 55 years, free of HF, from the population-based Rotterdam Study cohort, 4 Cox models were fitted using the predictors of the ACC/AHA, ARIC and Health-ABC risk scores. Performance of the models for 10-year HF prediction was evaluated. Afterwards, performance and net reclassification improvement (NRI) for adding NT-proBNP to the ACC/AHA model were assessed.
During a median follow-up of 13 years, 429 men and 489 women developed HF. The ARIC model had the highest performance [c-statistic (95% confidence interval [CI]): 0.80 (0.78; 0.83) and 0.80 (0.78; 0.83) in men and women, respectively]. The c-statistic for the ACC/AHA model was 0.76 (0.74; 0.78) in men and 0.77 (0.75; 0.80) in women. Adding NT-proBNP to the ACC/AHA model increased the c-statistic to 0.80 (0.78 to 0.83) in men and 0.81 (0.79 to 0.84) in women. Sensitivity and specificity of the ACC/AHA model did not drastically change after addition of NT-proBNP. NRI(95%CI) was - 23.8% (- 19.2%; - 28.4%) in men and - 27.6% (- 30.7%; - 24.5%) in women for events and 57.9% (54.8%; 61.0%) in men and 52.8% (50.3%; 55.5%) in women for non-events.
Acceptable performance of the model based on risk factors included in the ACC/AHA model advocates use of this model for prediction of HF risk in primary prevention setting. Addition of NT-proBNP modestly improved the model performance but did not lead to relevant discrimination improvement in clinical risk reclassification.