title: Utility of the SENIORS elderly heart failure risk model applied to the RICA registry of acute heart failure.
abstract: BACKGROUND
  Heart failure (HF) is predominantly a disease of the elderly. Reliable risk stratification would help in the management of this population, but no model has been well evaluated in elderly HF patients in both acute and chronic settings and not being restricted by ejection fraction. To evaluate the utility of the SENIORS risk model, developed from a clinical trial of elderly patients with chronic HF, in an independent cohort (National Spanish Registry: RICA) of elderly acute HF patients.
  
  
  METHODS
  We applied the SENIORS risk model to 926 patients in RICA to estimate risk at one year of a) composite outcome of all-cause mortality or cardiovascular hospital admission and b) all-cause mortality.
  
  
  RESULTS
  In the RICA registry mean age was 78years, mean ejection fraction 51% and 87% were in NYHA II and III. At one year death/CV hospitalization occurred in 31.9% and all-cause mortality in 19.5%. The risk model provided good separation of Kaplan Meier curves stratified by tertile for death/CV hospitalization and all-cause mortality. The observed versus expected rates of death/CV hospitalization in the lowest, middle and highest risk tertiles were (%) 34/24, 45/41 and 57/67, and for death 13/16, 32/38 and 44/70 respectively. C-statistic for all-cause mortality or CV hospitalization was 0.60 and for all-cause mortality 0.66.
  
  
  CONCLUSIONS
  The SENIORS risk model was a reliable tool for relative risk stratification among acute heart failure patients in a "real world" registry, but predicted versus observed risk showed some variability. The model provides a useful basis for clinical risk prediction.
authors.affiliation: Department of Internal Medicine, IMIBIC/Hospital Reina Sofia, University of Córdoba, Spain. Electronic address: fm1mopem@uco.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Montero-Perez-Barquero
authors.affiliation: Heart Failure and Vascular Risk Unit, Internal Medicine Department, Ramón y Cajal University Hospital, University of Alcalá, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.affiliation: Geriatric Unit, Internal Medicine Service, IDIBELL, University Hospital of Bellvitge, L'Hospitalet de Llobregat, Barcelona. Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: R Squared Statistical Consultancy, London UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Roughton
authors.affiliation: Joint Academic Office, Monash University, Australia and University of Warwick, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Coats
authors.affiliation: Department of Preventive Medicine and Public Health, School of Medicine, Autonoma University of Madrid/IdiPAZ, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodríguez-Artalejo
authors.affiliation: Department of Internal Medicine, Hospital Royo Villanova, Zaragoza, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Diez-Manglano
authors.affiliation: Department of Internal Medicine, Hospital Sao Joao, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Department of Internal Medicine, Hospital Manises, Valencia, Spain.
authors.forename: Pau
authors.initials: P
authors.lastname: Llacer
authors.affiliation: Norwich Medical School, University of East Anglia, Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008962:Models, Theoretical; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends
keywords: Heart failure; Morbidity; Mortality; Risk score