title: The first prognostic model for stroke and death in patients with systolic heart failure.
abstract: Patients with systolic heart failure (HF) are at increased risk of both ischemic stroke and death. Currently, no risk scores are available to identify HF patients at high risk of stroke or death. The Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial studied 2305 HF patients, in sinus rhythm, followed for up to 6 years (3.5±1.5 years). This trial showed no overall difference in those treated with warfarin vs aspirin with regard to death or stroke. The present study develops the first prognostic model to identify patients at higher risk of stroke or death based on their overall risk profile.
  
  
  
  A scoring algorithm using 8 readily obtainable clinical characteristics as predictors, age, gender, hemoglobin, blood urea nitrogen, ejection fraction, diastolic blood pressure, diabetes status, and prior stroke or transient ischemic attack (C-index=0.65, 95% CI: 0.613-0.681), was developed. It was validated internally using a bootstrap method. In predicting 1-year survival for death alone, our 8-predictor model had an AUC of 0.63 (95% CI: 0.579-0.678) while the 14-predictor Seattle model had an AUC of 0.72. The Seattle model did not report stroke.
  
  
  
  This novel prognostic model predicts the overall risk of ischemic stroke or death for HF patients. This model compares favorably for death with the Seattle model and has the added utility of including stroke as an endpoint. Use of this model will help identify those patients in need of more intensive monitoring and therapy and may help identify appropriate populations for trials of new therapies.
  
  
  
  http://www.Clinicatrials.govNCT00041938.
authors.affiliation: Lehigh Valley Health Network, Allentown, PA, USA; University of South Florida School of Medicine, Tampa, FL, USA. Electronic address: Ron.Freudenberger@gmail.com.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Freudenberger
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Bin
authors.initials: B
authors.lastname: Cheng
authors.affiliation: Washington University, St. Louis, MO, USA.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Mann
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: John L P
authors.initials: JL
authors.lastname: Thompson
authors.affiliation: University of Miami, Miami, FL, USA.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Buchsbaum
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sanford
authors.affiliation: University of Kent, Canterbury, UK.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Pullicino
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Levin
authors.affiliation: University of California - Medical School, San Francisco, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: State University of New York at Buffalo, Buffalo, NY, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Graham
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Mohr
authors.affiliation: University of South Florida School of Medicine, Tampa, FL, USA.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Labovitz
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: Centro Neurológico de Tratamiento y Rehabilitación, Buenos Aires, Argentina.
authors.forename: Conrado J
authors.initials: CJ
authors.lastname: Estol
authors.affiliation: Hospital Deventer, Deventer, Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Lok
authors.affiliation: Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Columbia University Medical Center, New York, NY, USA.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
mesh_terms: D000368:Aged; D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D019540:Area Under Curve; D001241:Aspirin / Q000627:therapeutic use; D002423:Cause of Death; D004311:Double-Blind Method; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D001241:Aspirin
keywords: Heart failure; Mortality; Risk factors; Stroke