Essen Stroke Risk Score Predicts Clinical Outcomes in Heart Failure Patients with Preserved Ejection Fraction: Evidence from the TOPCAT trial

Abstract

Heart failure with preserved ejection fraction (HFpEF) is associated with an increased risk of stroke.This study sought to determine whether the Essen Stroke Risk Score (ESRS) could predict the risks of adjudicated clinical outcomes in patients with Heart failure with preserved ejection fraction (HFpEF) from the TOPCAT trial. Of 3,441 HFpEF patients with a mean follow-up of 3.3 years, the risk of stroke ranged from 0.32% per year at an ESRS of 1-2 points to 1.71% per year at a score of ≥6 points. Each point increase in ESRS was associated with increased risks of stroke (HR=1.33 [95% CI 1.16-1.53]) with a C-index of 0.68, as well as myocardial infarction (HR=1.60 [95% CI 1.40-1.83]; C-index, 0.75), HF hospitalization (HR=1.30 [95% CI 1.20-1.41]; C-index, 0.71), any hospitalization (HR=1.20, 95% CI 1.15-1.26; C-index, 0.68), cardiovascular death (HR=1.32 [95% CI 1.20-1.44]; C-index, 0.68), and all-cause death (HR=1.37, [95% CI 1.28-1.48]; C-index, 0.68). The calibration curve showed that the ESRS had an adequate agreement between predicted and observed stroke risk. The ESRS had similar predictive abilities compared to the R2CHADS2, CHADS2, or CHA2DS2-VASC stroke scores as assessed by non-significant Z-statistics, NRI and IDI values.The ESRS had modest discriminatory abilities for predicting stroke as well as other adverse outcomes including myocardial infarction, hospitalization, and death in HFpEF patients. Furthermore, ESRS might have improvement in clinical usefulness compared with other scores in patients at high risk for stroke.

S2I2N0–3 score predicts short‐ and long‐term mortality and morbidity in HFrEF: a post‐hoc analysis of the GUIDE‐IT trial

“…We compared the C-index of the S 2 I 2 N 0-3 vs. MAGGIC score using the Z-statistic, while the net reclassification index (NRI) and relative integrated discrimination improvement (IDI) were used to evaluate the improvement of the S 2 I 2 N 0-3 score in predictive accuracy compared with the MAGGIC score. 14 All the statistical analyses were performed with R statistical software (Version 4.2.2), with packages epiDisplay, tidyverse, VIM, mice, survival, survminer, cmprsk, survIDINRI, timeROC, rms, riskRegression, and prodlim. Missing values were handled by the multiple imputation approach.…”

“…The efficacy of the S 2 I 2 N 0–3 score for each outcome was then assessed using the C‐index, which was calculated based on the area under the curve value of the corresponding ROC curve. We compared the C‐index of the S 2 I 2 N 0–3 vs. MAGGIC score using the Z‐statistic, while the net reclassification index (NRI) and relative integrated discrimination improvement (IDI) were used to evaluate the improvement of the S 2 I 2 N 0–3 score in predictive accuracy compared with the MAGGIC score 14 …”

Predicting Stroke in Heart Failure and Preserved Ejection Fraction Without Atrial Fibrillation

“…Two recent reports have provided the rate of stroke in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) but did not differentiate between patients with and without AF. 22,23 Therefore we analyzed the TOPCAT dataset (Americas only) to differentiate between patients with and without AF. Among the 1007 patients not in AF at baseline, 36 strokes occurred during a median follow-up of 2.6 years, giving a stroke rate of 12.4 (9.0-17.3) per 1000 patient-years, consistent with our findings (and lower than the rate among the 760 patients in TOPCAT with AF in whom the stroke rate was 18.7, 13.8–25.3, per 1000 patient-years).…”

Association of hypertension burden with stroke risk in patients with heart failure with preserved ejection fraction

“…The TOPCAT trial involved hemorrhagic, non-hemorrhagic, and other unknown stroke types as outcomes [ 18 ]. Patients were defined as having a hemorrhagic stroke if they were documented or examined to have hemorrhagic events; otherwise, they would be defined as non-hemorrhagic stroke (i.e., ischemic stroke).…”