Validation of the health ABC heart failure model for incident heart failure risk prediction: the Cardiovascular Health Study.
BACKGROUND
The recently developed and internally validated Health ABC HF model uses 9 routinely available clinical variables to determine incident heart failure risk. In this study, we sought to externally validate the Health ABC HF model.


RESULTS
Observed 5-year incidence of heart failure, defined as first hospitalization for new-onset heart failure, was compared with 5-year risk estimates derived from the Health ABC HF model among participants without heart failure at baseline in the Cardiovascular Health Study. During follow-up, 400 of 5335 (7.5%) participants developed heart failure over 5 years versus 364 (6.8%) predicted by the Health ABC HF model (predicted-to-observed ratio, 0.90). Observed versus predicted 5-year heart failure probabilities were 3.2% versus 2.8%, 9.0% versus 7.0%, 15.9% versus 13.7%, and 24.6% versus 30.8% for the <5%, 5% to 10%, 10% to 20%, and >20% 5-year risk categories, respectively. The Hosmer-Lemeshow chi(2) was 14.72 (degrees of freedom, 10; P=0.14), and the C index was 0.74 (95% CI, 0.72 to 0.76). Calibration and discrimination demonstrated adequate performance across sex and race overall; however, risk was underestimated in white men, especially in the 5% to 10% risk category. Model performance was optimal when participants with normal left ventricular function at baseline were assessed separately. Performance was consistent across age groups. Analyses with death as a competing risk yielded similar results.


CONCLUSIONS
The Health ABC HF model adequately predicted 5-year heart failure risk in a large community-based study, providing support for the external validity of the model. This tool may be used to identify individuals to whom to target heart failure prevention efforts.
Kalogeropoulos
Andreas
A
Department of Medicine, Division of Cardiology, Emory University, Atlanta, Ga 30322, USA.
Psaty
Bruce M
BM
Vasan
Ramachandran S
RS
Georgiopoulou
Vasiliki
V
Smith
Andrew L
AL
Smith
Nicholas L
NL
Kritchevsky
Stephen B
SB
Wilson
Peter W F
PW
Newman
Anne B
AB
Harris
Tamara B
TB
Butler
Javed
J
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D015233:Models, Statistical; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology