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Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan: Validation of risk models in decompensated heart failure

Nagai, Toshiyuki; Sundaram, Varun; Shoaib, Ahmad; Shiraishi, Yasuyuki; Kohsaka, Shun; Rothnie, Kieran J.; Piper, Susan; McDonagh, Theresa A.; Hardman, Suzanna M.C.; Goda, Ayumi; Mizuno, Atsushi; Sawano, Mitsuaki; Rigby, Alan S.; Quint, Jennifer K.; Yoshikawa, Tsutomu; Clark, Andrew L.; Anzai, Toshihisa; Cleland, John G.F.


Toshiyuki Nagai

Varun Sundaram

Ahmad Shoaib

Yasuyuki Shiraishi

Shun Kohsaka

Kieran J. Rothnie

Susan Piper

Theresa A. McDonagh

Suzanna M.C. Hardman

Ayumi Goda

Atsushi Mizuno

Mitsuaki Sawano

Jennifer K. Quint

Tsutomu Yoshikawa

Andrew L. Clark

Toshihisa Anzai

John G.F. Cleland


Aims: Prognostic models for hospitalised heart failure (HHF) were developed predominantly for patients of European origin in the United States of America; it is unclear whether they perform similarly in other health-care systems or for different ethnicities. We sought to validate published prediction models for HHF in the United Kingdom (UK) & Japan.

Methods and Results: Patients in the UK (894) and Japan (3,158) were prospectively enrolled and similar in terms of sex (~60% men) and median age (~77 years). Models predicted that British patients would have a higher mortality than Japanese, which was indeed true both for in-hospital [4.8% vs 2.5%] and 180-day [20.7% vs 9.5%] mortality. The model c-statistics for the published/derivation [range 0.70-0.76] and Japanese [range 0.75-0.77] cohorts were similar and higher than for the UK [0.62-0.75] but models consistently over-estimated mortality in Japan. For in-hospital mortality, OPTIMIZE-HF performed best, providing similar discrimination in published/derivation, UK and Japanese cohorts [c-indices: 0.75 (0.74-0.77); 0.75 (0.68 - 0.81) and 0.77 (0.70 - 0.83)], and least over-estimated mortality in Japan. For 180-day mortality, the cstatistics for ASCEND-HF were similar in published/derivation [0.70] and UK [0.69 (0.64 - 0.74)] cohorts but higher in Japan [0.75 (0.71 - 0.79)]; calibration was good in the UK but again over-estimated mortality in Japan.

Conclusion: Calibration of published prediction models appear moderately accurate and unbiased when applied to British patients but consistently overestimate mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest.


Nagai, T., Sundaram, V., Shoaib, A., Shiraishi, Y., Kohsaka, S., Rothnie, K. J., …Cleland, J. G. (2018). Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan: Validation of risk models in decompensated heart failure. European journal of heart failure, 20(8), 1179-1190.

Journal Article Type Article
Acceptance Date Apr 9, 2018
Online Publication Date May 30, 2018
Publication Date Aug 3, 2018
Deposit Date Apr 16, 2018
Publicly Available Date May 31, 2019
Print ISSN 1388-9842
Electronic ISSN 1879-0844
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 20
Issue 8
Pages 1179-1190
Keywords Acute heart failure; hospitalised heart failure; mortality prediction; Outcome; Japan
Public URL
Publisher URL
Additional Information This is the accepted version of an article published in European Journal of Heart Failure.


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