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.
Kieran J. Rothnie
Theresa A. McDonagh
Suzanna M.C. Hardman
Alan S. Rigby
Jennifer K. Quint
Andrew L. Clark
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.
|Journal Article Type||Article|
|Publication Date||Aug 3, 2018|
|Peer Reviewed||Peer Reviewed|
|APA6 Citation||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. https://doi.org/10.1002/ejhf.1210|
|Keywords||Acute heart failure; hospitalised heart failure; mortality prediction; Outcome; Japan|
|Copyright Statement||©2018 University of Hull|
|Additional Information||This is the accepted version of an article published in European Journal of Heart Failure.|
©2018 University of Hull
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