TY - JOUR
T1 - Personalized lifetime prediction of survival and treatment benefit in patients with heart failure with reduced ejection fraction
T2 - The LIFE-HF model
AU - Burger, Pascal M.
AU - Savarese, Gianluigi
AU - Tromp, Jasper
AU - Adamson, Carly
AU - Jhund, Pardeep S.
AU - Benson, Lina
AU - Hage, Camilla
AU - Tay, Wan Ting
AU - Solomon, Scott D.
AU - Packer, Milton
AU - Rossello, Xavier
AU - McEvoy, John W.
AU - De Bacquer, Dirk
AU - Timmis, Adam
AU - Vardas, Panos
AU - Graham, Ian M.
AU - Di Angelantonio, Emanuele
AU - Visseren, Frank L.J.
AU - McMurray, John J.V.
AU - Lam, Carolyn S.P.
AU - Lund, Lars H.
AU - Koudstaal, Stefan
AU - Dorresteijn, Jannick A.N.
AU - Mosterd, Arend
N1 - Publisher Copyright:
© 2023 European Society of Cardiology.
PY - 2023/11
Y1 - 2023/11
N2 - Aims: Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. Methods and results: Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65–0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium–glucose cotransporter 2 inhibitor, and angiotensin receptor–neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7–3.7) and 3.7 (IQR 2.4–5.5) additional years of overall and HF hospitalization-free survival, respectively. Conclusion: The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.
AB - Aims: Although trials have proven the group-level effectiveness of various therapies for heart failure with reduced ejection fraction (HFrEF), important differences in absolute effectiveness exist between individuals. We developed and validated the LIFEtime-perspective for Heart Failure (LIFE-HF) model for the prediction of individual (lifetime) risk and treatment benefit in patients with HFrEF. Methods and results: Cox proportional hazards functions with age as the time scale were developed in the PARADIGM-HF and ATMOSPHERE trials (n = 15 415). Outcomes were cardiovascular death, heart failure (HF) hospitalization or cardiovascular death, and non-cardiovascular mortality. Predictors were age, sex, New York Heart Association class, prior HF hospitalization, diabetes mellitus, extracardiac vascular disease, systolic blood pressure, left ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and glomerular filtration rate. The functions were combined in life-tables to predict individual overall and HF hospitalization-free survival. External validation was performed in the SwedeHF registry, ASIAN-HF registry, and DAPA-HF trial (n = 51 286). Calibration of 2- to 10-year risk was adequate, and c-statistics were 0.65–0.74. An interactive tool was developed combining the model with hazard ratios from trials to allow estimation of an individual's (lifetime) risk and treatment benefit in clinical practice. Applying the tool to the development cohort, combined treatment with a mineralocorticoid receptor antagonist, sodium–glucose cotransporter 2 inhibitor, and angiotensin receptor–neprilysin inhibitor was estimated to afford a median of 2.5 (interquartile range [IQR] 1.7–3.7) and 3.7 (IQR 2.4–5.5) additional years of overall and HF hospitalization-free survival, respectively. Conclusion: The LIFE-HF model enables estimation of lifelong overall and HF hospitalization-free survival, and (lifetime) treatment benefit for individual patients with HFrEF. It could serve as a tool to improve the management of HFrEF by facilitating personalized medicine and shared decision-making.
KW - Heart failure with reduced ejection fraction
KW - Individual treatment benefit
KW - Lifetime risk
KW - Personalized medicine
KW - Risk prediction
KW - Shared decision-making
UR - http://www.scopus.com/inward/record.url?scp=85171362055&partnerID=8YFLogxK
U2 - 10.1002/ejhf.3028
DO - 10.1002/ejhf.3028
M3 - Article
C2 - 37691140
AN - SCOPUS:85171362055
SN - 1388-9842
VL - 25
SP - 1962
EP - 1975
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 11
ER -