Prediction of mortality and mode of death in heart failure using multimorbidity and clinical risk score systems: a nationwide analysis

Heart failure (HF) is associated with a higher mortality, but modes of death may vary and their respective predictors have been insufficiently defined. Charlson comorbidity index (CCI) is a tool to quantify multimorbidity and a strong estimator of mortality. The quantifiable frailty phenotype is also predictive of mortality and disability and claims data can be used to classify individuals as frail and non-frail using the Hospital Frailty Risk Score (HFRS). CHA2DS2-VASc score was originally employed as a risk assessment tool for stroke in patients with AF but this comprehensive risk assessment score may help identify HF patients who are at high risk for mortality. We evaluated whether these tools may help to predict mortality and the different modes of death in HF.

Based on the France nationwide administrative hospital-discharge database, the analysis focused on all patients with HF hospitalized in France in 2012, with at least 5 years of complete follow-up (or dead earlier) as described by others. We identified 371,848 consecutive patients hospitalized with HF seen in 2012 and followed until December 2019. Adverse outcomes were investigated during follow-up. CHA2DS2VASc score, CCI and HFRS were calculated for each patient.

Among these 371,848 patients with HF, 220,774 patients died during a follow-up of 4.0±2.8 years (median 4.8) (yearly rate 14.8%, 31.3% cardiovascular and 68.6% non-cardiovascular deaths). Death occurred more often in patients with higher CHA2DS2VASc, CCI and HFRS scores. HFRS was a better predictor of total mortality than CCI and CHA2DS2VASc score (see C-statistics in Table 1). However, the CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and HFRS. By contrast, HFRS was a better predictor of non-cardiovascular mortality than CCI and CHA2DS2VASc score. The optimal predictive performances were better for non-cardiovascular death than for cardiovascular death.

Multimorbidity and frailty assessed with HFRS demonstrated better performances in predicting total mortality and non-cardiovascular mortality than CCI and CHA2DS2VASc score in HF patients. By contrast, CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and HFRS in these patients.

Type of funding sources: None.