Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan |
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| Authors: | Toshiyuki Nagai Varun Sundaram Ahmad Shoaib Yasuyuki Shiraishi Shun Kohsaka Kieran J Rothnie Susan Piper Theresa A McDonagh Suzanna MC Hardman Ayumi Goda Atsushi Mizuno Mitsuaki Sawano Alan S Rigby Jennifer K Quint Tsutomu Yoshikawa Andrew L Clark Toshihisa Anzai John GF Cleland |
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| Institution: | 1. National Heart & Lung Institute, Imperial College London, London, UK;2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan;3. Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan;4. Harington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA, and Royal Brompton and Harefield Hospitals, London, UK;5. Department of Cardiology, Hull York Medical School, Castle Hill Hospital, Kingston‐upon‐Hull, UK;6. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan;7. Cardiology Department, King's College Hospital, London, UK;8. Clinical & Academic Department of Cardiovascular Medicine, Whittington Hospital, London, UK;9. Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan;10. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan;11. Department of Statistics, Hull York Medical School, University of Hull, Kingston‐upon‐Hull, UK;12. Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan;13. Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow and National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College London, London, UK |
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| Abstract: | Aims Prognostic models for hospitalized 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) and Japan. Methods and results Patients in the UK (n =894) and Japan (n =3158) were prospectively enrolled and were 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 overestimated mortality in Japan. For in‐hospital mortality, the OPTIMIZE‐HF model 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), respectively], and least overestimated mortality in Japan. For 180‐day mortality, the c‐statistics for the ASCEND‐HF model 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 overestimated mortality in Japan. Conclusion Calibration of published prediction models appears moderately accurate and unbiased when applied to British patients but consistently overestimates mortality in Japan. Identifying the reason why patients in Japan have a better than predicted prognosis is of great interest. |
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| Keywords: | Acute heart failure Hospitalized heart failure Mortality prediction Outcome Japan |
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