Population risk prediction models for incident heart failure: a systematic review.
BACKGROUND
The prevalence of heart failure is expected to significantly rise unless high-risk patients are effectively screened and appropriate, cost-effective prevention interventions are implemented.


RESULTS
We performed a systematic review to evaluate the prediction characteristics of the published heart failure risk prediction models as of August 2014 using MEDLINE and EMBASE databases. Eligible studies reported the development, validation, or impact assessment of a model. Two investigators performed independent review to extract data on study design and characteristics, risk predictors, discrimination, calibration, and reclassification ability of models, as well as validation and impact analysis. We included 13 publications reporting on 28 heart failure risk prediction models. Models had acceptable-to-good discriminatory ability (c-statistics, >0.70) in the derivation sample. Calibration was less commonly assessed, but was acceptable when it was. Only 2 models were externally validated more than once, displaying modest-to-acceptable discrimination (c-statistics, 0.61-0.79). When assessed, novel blood and imaging markers modestly improved risk prediction. One model assessed the prediction properties in race-based subgroups, whereas 2 models evaluated sex-based subgroups. Impact analysis found none of the models recommended for use in any clinical practice guideline.


CONCLUSIONS
Incident heart failure risk prediction remains at an early stage. The discrimination ability of current models is acceptable in derivation data sets but most models have not been externally validated. It remains unclear which models are cost-effective and best suit population screening needs. The effects of models on clinical and preventative care requires further study.
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
Justin B
JB
Echouffo-Tcheugui
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
Stephen J
SJ
Greene
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
Lampros
L
Papadimitriou
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
Faiez
F
Zannad
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
Clyde W
CW
Yancy
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.).
Mihai
M
Gheorghiade
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (J.B.E.-T.); Center for Cardiovascular Innovation, Department of Medicine (S.J.G., M.G.) and Department of Cardiology (C.W.Y.), Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Medicine, Stony Brook University, NY (L.P., J.B.); and CHU Nancy, Department of Cardiology, Institute of Lorraine Heart and Blood Vessels, Nancy, France (F.Z.). javed.butler@stonybrookmedicine.edu.
Javed
J
Butler
D003661:Decision Support Techniques; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
calibration; discrimination; heart failure; prevention