Nagai, T, Sundaram, V, Shoaib, A, Shiraishi, Y, Kohsaka, S, Rothnie, KJ, Piper, S, McDonagh, TA, Hardman, SMC, Goda, A, Mizuno, A, Sawano, M, Rigby, AS, Quint, JK, Yoshikawa, T, Clark, AL, Anzai, T and Cleland, JGF (2018) Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan. European Journal of Heart Failure, 20 (8). 1179 - 1190.

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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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Wiley-Blackwell at https://doi.org/10.1002/ejhf.1210 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: acute heart failure, hospitalized heart failure, Japan, mortality prediction, outcome, aged, aged 80 or over, female, heart failure, hospital mortality, humans, inpatients, male, models, statistical, prognosis, prospective studies, reproducibility of results, survival rate, United Kingdom
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 30 Aug 2019 08:31
Last Modified: 30 Aug 2019 08:35
URI: http://eprints.keele.ac.uk/id/eprint/6743

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