Visual Abstract
Early prediction of onset Heart Failure (HF) in patients with stable diabetes have been elusive. This study aimed to predict the first occurrence of HF among diabetes patients. A time-varying Cox model was derived from ACCORD trial to predict the risk of incident CHF, defined by CHF hospitalization. Candidate variables were chosen based on literature reviews and experts consultation. Predictors were selected from candidate variables using a stepwise algorithm. Model performance was evaluated by Brier score and C-index. The model was transformed into an integer-based scoring algorithm (0~100) for 5-year risk of incident HF. A total of 9,649 diabetes patients free of CHF were extracted, with median follow-up of 4 years and 299 CHF events. Sixteen variables were selected among the candidate variables to develop the CHF risk model. The model demonstrated good discrimination (C-index 0.838 [95% CI 0.821-0.855]) and calibration (Brier Score 0.0064 [95% CI 0.006-0.007]) in ACCORD data. The 5-year incident HF increased in a graded fashion with 5-quintile: ≤1% risk in quintile 1 (risk score ≤ 28), 1%-5% risk in quintile 2 (risk score 29-41), 5%-10% risk in quintile 3 (risk score 42-47), 10%-20% risk in quintile 4 (risk score 48-53), and ≥20% in quintile 5 (risk score ≥54). We have developed and transformed a dynamic risk prediction of incident CHF into a risk score for population risk stratification for HF among T2DM patients.
Y. Lin: None. H. Shao: Research Support; Self; Sanofi. V. Fonseca: Consultant; Self; Abbott Diabetes, Asahi Kasei Corporation, Bayer Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Intarcia Therapeutics, Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Stock/Shareholder; Self; Amgen Inc., Bravo4health, Mellitus Health. L. Shi: Research Support; Self; AstraZeneca, Sanofi.
