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Development and validation of a prognostic score integrating remote heart failure symptoms and clinical variables in mortality risk prediction after myocardial infarction: the PragueMi score
Abstract Aims While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients’ stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remo...
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Published in: | European journal of preventive cardiology 2024-10, Vol.31 (14), p.1713-1720 |
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container_issue | 14 |
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container_title | European journal of preventive cardiology |
container_volume | 31 |
creator | Wohlfahrt, Peter Jenča, Dominik Melenovský, Vojtěch Stehlik, Josef Mrázková, Jolana Šramko, Marek Kotrč, Martin Želízko, Michael Adámková, Věra Piťha, Jan Kautzner, Josef |
description | Abstract
Aims
While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients’ stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended Global Registry of Acute Coronary Events (GRACE) score.
Methods and results
A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. Data from 1135 patients (aged 64 ± 12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire and clinical variables were used as possible predictors. The best model included the following variables: age, HF history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months [the area under the receiver operating curve (AUC) 90.1, 95% confidence interval (CI) 81.8–98.4 vs. 77.4, 95% CI 62.2–92.5, P = 0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5–96.0 vs. 76.2, 95% CI 64.7–87.7, P = 0.004).
Conclusion
The PragueMi score combining HF symptoms and clinical variables performs better than the currently recommended GRACE score.
Lay Summary
The prognosis of patients after myocardial infarction is heterogeneous. Thus, risk stratification is needed to identify and intervene patients at increased risk. While heart failure (HF) symptoms are associated with adverse prognosis, they are not used for patients’ stratification.
We have developed and internally validated the PragueMi score, which integrates clinical risk factors at the time of hospitalization and HF symptoms determined remotely by a questionnaire 1 month after hospital discharge.
PragueMi score was able to better stratify patients’ risk as compared with the currently recommended Global Registry of Acute Coronary Events score.
Graphical Abstract
Graphical Abstract |
doi_str_mv | 10.1093/eurjpc/zwae114 |
format | article |
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Aims
While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients’ stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended Global Registry of Acute Coronary Events (GRACE) score.
Methods and results
A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. Data from 1135 patients (aged 64 ± 12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire and clinical variables were used as possible predictors. The best model included the following variables: age, HF history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months [the area under the receiver operating curve (AUC) 90.1, 95% confidence interval (CI) 81.8–98.4 vs. 77.4, 95% CI 62.2–92.5, P = 0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5–96.0 vs. 76.2, 95% CI 64.7–87.7, P = 0.004).
Conclusion
The PragueMi score combining HF symptoms and clinical variables performs better than the currently recommended GRACE score.
Lay Summary
The prognosis of patients after myocardial infarction is heterogeneous. Thus, risk stratification is needed to identify and intervene patients at increased risk. While heart failure (HF) symptoms are associated with adverse prognosis, they are not used for patients’ stratification.
We have developed and internally validated the PragueMi score, which integrates clinical risk factors at the time of hospitalization and HF symptoms determined remotely by a questionnaire 1 month after hospital discharge.
PragueMi score was able to better stratify patients’ risk as compared with the currently recommended Global Registry of Acute Coronary Events score.
Graphical Abstract
Graphical Abstract</description><identifier>ISSN: 2047-4873</identifier><identifier>ISSN: 2047-4881</identifier><identifier>EISSN: 2047-4881</identifier><identifier>DOI: 10.1093/eurjpc/zwae114</identifier><identifier>PMID: 38497201</identifier><language>eng</language><publisher>UK: Oxford University Press</publisher><ispartof>European journal of preventive cardiology, 2024-10, Vol.31 (14), p.1713-1720</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. 2024</rights><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c299t-49476a43a366d0144260c27c172f989185f7bcb71de701538b24cbecc8c5f4fe3</citedby><cites>FETCH-LOGICAL-c299t-49476a43a366d0144260c27c172f989185f7bcb71de701538b24cbecc8c5f4fe3</cites><orcidid>0000-0002-1632-6182 ; 0000-0003-2390-526X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38497201$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wohlfahrt, Peter</creatorcontrib><creatorcontrib>Jenča, Dominik</creatorcontrib><creatorcontrib>Melenovský, Vojtěch</creatorcontrib><creatorcontrib>Stehlik, Josef</creatorcontrib><creatorcontrib>Mrázková, Jolana</creatorcontrib><creatorcontrib>Šramko, Marek</creatorcontrib><creatorcontrib>Kotrč, Martin</creatorcontrib><creatorcontrib>Želízko, Michael</creatorcontrib><creatorcontrib>Adámková, Věra</creatorcontrib><creatorcontrib>Piťha, Jan</creatorcontrib><creatorcontrib>Kautzner, Josef</creatorcontrib><title>Development and validation of a prognostic score integrating remote heart failure symptoms and clinical variables in mortality risk prediction after myocardial infarction: the PragueMi score</title><title>European journal of preventive cardiology</title><addtitle>Eur J Prev Cardiol</addtitle><description>Abstract
Aims
While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients’ stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended Global Registry of Acute Coronary Events (GRACE) score.
Methods and results
A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. Data from 1135 patients (aged 64 ± 12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire and clinical variables were used as possible predictors. The best model included the following variables: age, HF history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months [the area under the receiver operating curve (AUC) 90.1, 95% confidence interval (CI) 81.8–98.4 vs. 77.4, 95% CI 62.2–92.5, P = 0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5–96.0 vs. 76.2, 95% CI 64.7–87.7, P = 0.004).
Conclusion
The PragueMi score combining HF symptoms and clinical variables performs better than the currently recommended GRACE score.
Lay Summary
The prognosis of patients after myocardial infarction is heterogeneous. Thus, risk stratification is needed to identify and intervene patients at increased risk. While heart failure (HF) symptoms are associated with adverse prognosis, they are not used for patients’ stratification.
We have developed and internally validated the PragueMi score, which integrates clinical risk factors at the time of hospitalization and HF symptoms determined remotely by a questionnaire 1 month after hospital discharge.
PragueMi score was able to better stratify patients’ risk as compared with the currently recommended Global Registry of Acute Coronary Events score.
Graphical Abstract
Graphical Abstract</description><issn>2047-4873</issn><issn>2047-4881</issn><issn>2047-4881</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNqFkU1vFSEUhonR2KZ269Kw1MVtgeEOjDvT-pXU6ELXkzPM4ZbKwAhMzfXH-dvEO9duZQMJz3lewkvIc84uOOuaS1zS3Wwuf_0E5Fw-IqeCSbWRWvPHD2fVnJDznO9YXS0TQuun5KTRslOC8VPy-xrv0cd5wlAohJHeg3cjFBcDjZYCnVPchZiLMzSbmJC6UHCXKhF2NOEUC9JbhFSoBeeXCuT9NJc45YPOeBecAV-9ycHgMVcBnWIqNafsaXL5e83A0ZlDJtiCiU77aCCNrs65YCEd7l7Tcov0S4Ldgp_c-ppn5IkFn_H8uJ-Rb-_efr36sLn5_P7j1ZubjRFdVzayk6oF2UDTtiPjUoqWGaEMV8J2uuN6a9VgBsVHVIxvGz0IaQY0RputlRabM_Jy9dbv-LFgLv3kskHvIWBcci-6VrGWC8YqerGiJsWcE9p-Tm6CtO856__W1q-19cfa6sCLo3sZJhwf8H8lVeDVCsRl_p_sDyYgqa4</recordid><startdate>20241010</startdate><enddate>20241010</enddate><creator>Wohlfahrt, Peter</creator><creator>Jenča, Dominik</creator><creator>Melenovský, Vojtěch</creator><creator>Stehlik, Josef</creator><creator>Mrázková, Jolana</creator><creator>Šramko, Marek</creator><creator>Kotrč, Martin</creator><creator>Želízko, Michael</creator><creator>Adámková, Věra</creator><creator>Piťha, Jan</creator><creator>Kautzner, Josef</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1632-6182</orcidid><orcidid>https://orcid.org/0000-0003-2390-526X</orcidid></search><sort><creationdate>20241010</creationdate><title>Development and validation of a prognostic score integrating remote heart failure symptoms and clinical variables in mortality risk prediction after myocardial infarction: the PragueMi score</title><author>Wohlfahrt, Peter ; Jenča, Dominik ; Melenovský, Vojtěch ; Stehlik, Josef ; Mrázková, Jolana ; Šramko, Marek ; Kotrč, Martin ; Želízko, Michael ; Adámková, Věra ; Piťha, Jan ; Kautzner, Josef</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c299t-49476a43a366d0144260c27c172f989185f7bcb71de701538b24cbecc8c5f4fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wohlfahrt, Peter</creatorcontrib><creatorcontrib>Jenča, Dominik</creatorcontrib><creatorcontrib>Melenovský, Vojtěch</creatorcontrib><creatorcontrib>Stehlik, Josef</creatorcontrib><creatorcontrib>Mrázková, Jolana</creatorcontrib><creatorcontrib>Šramko, Marek</creatorcontrib><creatorcontrib>Kotrč, Martin</creatorcontrib><creatorcontrib>Želízko, Michael</creatorcontrib><creatorcontrib>Adámková, Věra</creatorcontrib><creatorcontrib>Piťha, Jan</creatorcontrib><creatorcontrib>Kautzner, Josef</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of preventive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wohlfahrt, Peter</au><au>Jenča, Dominik</au><au>Melenovský, Vojtěch</au><au>Stehlik, Josef</au><au>Mrázková, Jolana</au><au>Šramko, Marek</au><au>Kotrč, Martin</au><au>Želízko, Michael</au><au>Adámková, Věra</au><au>Piťha, Jan</au><au>Kautzner, Josef</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development and validation of a prognostic score integrating remote heart failure symptoms and clinical variables in mortality risk prediction after myocardial infarction: the PragueMi score</atitle><jtitle>European journal of preventive cardiology</jtitle><addtitle>Eur J Prev Cardiol</addtitle><date>2024-10-10</date><risdate>2024</risdate><volume>31</volume><issue>14</issue><spage>1713</spage><epage>1720</epage><pages>1713-1720</pages><issn>2047-4873</issn><issn>2047-4881</issn><eissn>2047-4881</eissn><abstract>Abstract
Aims
While heart failure (HF) symptoms are associated with adverse prognosis after myocardial infarction (MI), they are not routinely used for patients’ stratification. The primary objective of this study was to develop and validate a score to predict mortality risk after MI, combining remotely recorded HF symptoms and clinical risk factors, and to compare it against the guideline-recommended Global Registry of Acute Coronary Events (GRACE) score.
Methods and results
A cohort study design using prospectively collected data from consecutive patients hospitalized for MI at a large tertiary heart centre between June 2017 and September 2022 was used. Data from 1135 patients (aged 64 ± 12 years, 26.7% women), were split into derivation (70%) and validation cohort (30%). Components of the 23-item Kansas City Cardiomyopathy Questionnaire and clinical variables were used as possible predictors. The best model included the following variables: age, HF history, admission creatinine and heart rate, ejection fraction at hospital discharge, and HF symptoms 1 month after discharge including walking impairment, leg swelling, and change in HF symptoms. Based on these variables, the PragueMi score was developed. In the validation cohort, the PragueMi score showed superior discrimination to the GRACE score for 6 months [the area under the receiver operating curve (AUC) 90.1, 95% confidence interval (CI) 81.8–98.4 vs. 77.4, 95% CI 62.2–92.5, P = 0.04) and 1-year risk prediction (AUC 89.7, 95% CI 83.5–96.0 vs. 76.2, 95% CI 64.7–87.7, P = 0.004).
Conclusion
The PragueMi score combining HF symptoms and clinical variables performs better than the currently recommended GRACE score.
Lay Summary
The prognosis of patients after myocardial infarction is heterogeneous. Thus, risk stratification is needed to identify and intervene patients at increased risk. While heart failure (HF) symptoms are associated with adverse prognosis, they are not used for patients’ stratification.
We have developed and internally validated the PragueMi score, which integrates clinical risk factors at the time of hospitalization and HF symptoms determined remotely by a questionnaire 1 month after hospital discharge.
PragueMi score was able to better stratify patients’ risk as compared with the currently recommended Global Registry of Acute Coronary Events score.
Graphical Abstract
Graphical Abstract</abstract><cop>UK</cop><pub>Oxford University Press</pub><pmid>38497201</pmid><doi>10.1093/eurjpc/zwae114</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1632-6182</orcidid><orcidid>https://orcid.org/0000-0003-2390-526X</orcidid><oa>free_for_read</oa></addata></record> |
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title | Development and validation of a prognostic score integrating remote heart failure symptoms and clinical variables in mortality risk prediction after myocardial infarction: the PragueMi score |
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