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American Heart Association

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Final ID: MDP298

PREDICTIVE MODELS AID PHYSICIAN PROGNOSTICATION: A SECONDARY ANALYSIS EVALUATING INTEGRATED MODEL AND PHYSICIAN PROGNOSTIC ESTIMATES IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

Abstract Body (Do not enter title and authors here): Background: In recent studies from a multicenter Canadian cohort of outpatients with heart failure (HF), we found that model predictions were significantly more accurate than HF cardiologists. In this study, trying to mimic practice, we evaluated the additional predictive value and clinical impact of model predictions to refine physician estimated risk of 1-year mortality by combining model and physician estimates.
Methods: We included consented consecutive HF outpatients (LVEF <40%) followed at 11 HF clinics in Canada. HF cardiologists estimated patient 1-year mortality using their clinical judgment. We calculated model predicted mortality using the Seattle HF Model (SHFM). We followed patients for at least a year to record mortality (or urgent heart transplant or ventricular assist device implant as mortality-equivalent events). Using random forest survival model and cross-validation, we compared the performance SHFM and the HF cardiologist alone, and the integrated HF cardiologist and the SHFM predictions by evaluating model discrimination (c-statistic), calibration (observed vs predicted event rate), risk reclassification and clinical net benefit analyses.
Results: Among 1,643 HF patients, 1-year event rate was 9% (95%CI 8%-11%). The SHFM had the adequate discrimination (c-statistic 0.76) and excellent calibration while cardiologists showed adequate discrimination (c-statistic 0.75) and poor calibration with significant risk overestimation (Figure 1). When the SHFM estimates were added physician predictions, discrimination significantly improved (0.82, 95%CI 0.78-0.86) with excellent calibration. By risk reclassification analysis, among patients with events, HF cardiologist better reclassified 44% than the SHFM or the integrated model. Among patients without event, however, HF cardiologists worse risk-classified 52% in comparison to SHFM and 71% to the integrated model. By net clinical benefit analysis (Figure 2), when the decision to treat involves patients with 1-year mortality of >5%, SHFM predictions would lead to higher benefit than guiding care by physician judgement. Integrating model and HF cardiologist predictions led to minimally increased benefit in comparison to SHFM alone.
Conclusions: Integrating prediction from the SHFM to physician judgment or using the SHFM alone showed superior accuracy than HF cardiologist predictions, proving that model-informed care may provide more accurate prognostic information to tailor clinical decision making.
  • Alba, Ana  ( PMCC - University Health Network , Toronto , Ontario , Canada )
  • Porepa, Liane  ( Southlake Regional Health Centre , Newmarket , Ontario , Canada )
  • Demers, Catherine  ( MCMASTER UNIVERSITY , Burlingon , Ontario , Canada )
  • Chih, Sharon  ( Ottawa Heart Institute , Ottawa , Ontario , Canada )
  • Giannetti, Nadia  ( McGill University , Montreal , Quebec , Canada )
  • Rac, Valeria  ( Toronto General Hospital , Toronto , Ontario , Canada )
  • Ross, Heather  ( PMCC - University Health Network , Toronto , Ontario , Canada )
  • Guyatt, Gordon  ( McMaster University , Hamilton , Ontario , Canada )
  • Buchan, Tayler  ( PMCC - University Health Network , Toronto , Ontario , Canada )
  • Mueller, Brigitte  ( PMCC - University Health Network , Toronto , Ontario , Canada )
  • Fan, Chun-po  ( PMCC - University Health Network , Toronto , Ontario , Canada )
  • Poon, Stephanie  ( Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada )
  • Mak, Susanna  ( Mount Sinai Hospital , Toronto , Ontario , Canada )
  • Toma, Mustafa  ( ST PAULS HOSPITAL , Vancouver , British Columbia , Canada )
  • Zieroth, Shelley  ( University of Manitoba , Winnipeg , Manitoba , Canada )
  • Anderson, Kim  ( Nova Scotia Health Authority , Hallifax , Nova Scotia , Canada )
  • Author Disclosures:
    Ana Alba: DO NOT have relevant financial relationships | Liane Porepa: No Answer | Catherine Demers: DO have relevant financial relationships ; Research Funding (PI or named investigator):BMS:Active (exists now) ; Research Funding (PI or named investigator):NovoNordisk:Active (exists now) ; Speaker:Sanofi:Active (exists now) ; Research Funding (PI or named investigator):Acceleron:Active (exists now) | Sharon Chih: DO NOT have relevant financial relationships | Nadia Giannetti: No Answer | Valeria Rac: No Answer | Heather Ross: DO NOT have relevant financial relationships | Gordon Guyatt: DO NOT have relevant financial relationships | Tayler Buchan: DO NOT have relevant financial relationships | Brigitte Mueller: DO NOT have relevant financial relationships | Chun-Po Fan: DO NOT have relevant financial relationships | Stephanie Poon: No Answer | Susanna Mak: No Answer | Mustafa Toma: DO NOT have relevant financial relationships | Shelley Zieroth: DO have relevant financial relationships ; Consultant:Novartis:Past (completed) | Kim Anderson: No Answer
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Hot Topics in Heart Failure Research

Saturday, 11/16/2024 , 11:10AM - 12:35PM

Moderated Digital Poster Session

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