Performance of Prognostic Risk Scores in Heart Failure Patients: Do Sex Differences Exist?

Abstract Background Sex differences in the performance of prognostic risk scores in heart failure (HF) patients has not been previously investigated. We examined the performance of two commonly used scores in predicting mortality and a composite endpoint (CEP) consisting of ventricular assist device, heart transplantation or mortality, in women versus men with HF. Methods A retrospective study of 1,136 (25% women) consecutive ambulatory adult HF patients with reduced left ventricular ejection fraction 40% followed at a single institution between 2000-2012. Discrimination, calibration, and absolute risk reclassification of the Seattle Heart Failure Model (SHFM) and the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score to predict 1- and 3-year outcomes were compared in women and men. Results At 1- and 3-year follow-up, 116 (22% women) and 231 (21% women) patients died, respectively. Survival was equal between sexes (p=0.41). The SHFM and the MAGGIC score showed similar discriminatory capacity in women (C-statistic:0.84, 95%CI:0.77-0.92, and 0.74, 95%CI:0.64-0.83) and men (C-statistic:0.74, 95%CI:0.69-0.79, and 0.70, 95%CI:0.64-0.75). There was no difference in the predicted and observed 1-year mortality by the scores in both sexes. Compared to the SHFM, the MAGGIC score better reclassified 10% (95%CI:7%-14%) of women and 18% (95%CI:15%-20%) of men. At 3-year follow-up, similar results were seen for discrimination, whereas both scores overestimated mortality with more marked overestimation in women. The results were reproducible for CEP; with improved calibration at 3-year follow-up in both scores. Conclusion Our findings support the use of the MAGGIC score in both women and men due to better risk classification.