A Biomarker-Based Score for Risk of Hospitalization for Heart Failure in Patients With Diabetes

Author:

Berg David D.1ORCID,Wiviott Stephen D.1,Scirica Benjamin M.1,Zelniker Thomas A.2,Goodrich Erica L.1,Jarolim Petr3,Mosenzon Ofri45,Cahn Avivit45,Bhatt Deepak L.6,Leiter Lawrence A.7,McGuire Darren K.8,Wilding John P.H.9,Johanson Per10,Langkilde Anna Maria10,Raz Itamar45,Braunwald Eugene1,Sabatine Marc S.1,Morrow David A.1

Affiliation:

1. TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

2. Division of Cardiology, Vienna General Hospital and Medical University of Vienna, Austria

3. Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

4. Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

5. Diabetes Unit, Department of Endocrinology and Metabolism, Hadassah Medical Center, Jerusalem, Israel

6. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

7. Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada

8. University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX

9. Department of Cardiovascular and Metabolic Medicine, Aintree University Hospital, University of Liverpool, Liverpool, U.K.

10. AstraZeneca, Goteborg, Sweden

Abstract

OBJECTIVE Heart failure (HF) is an impactful complication of type 2 diabetes mellitus (T2DM). We aimed to develop and validate a risk score for hospitalization for HF (HHF) incorporating biomarkers and clinical factor(s) in patients with T2DM. RESEARCH DESIGN AND METHODS We derived a risk score for HHF using clinical data, high-sensitivity troponin T (hsTnT), and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) from 6,106 placebo-treated patients with T2DM in SAVOR-TIMI 53 (Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus–Thrombolysis in Myocardial Infarction 53). Candidate variables were assessed using Cox regression. The strongest indicators of HHF risk were included in the score using integer weights. The score was externally validated in 7,251 placebo-treated patients in DECLARE-TIMI 58 (Dapagliflozin Effect on CardiovascuLAR Events–Thrombolysis in Myocardial Infarction 58). The effect of dapagliflozin on HHF was assessed by risk category in DECLARE-TIMI 58. RESULTS The strongest indicators of HHF risk were NT-proBNP, prior HF, and hsTnT (each P < 0.001). A risk score using these three variables identified a gradient of HHF risk (P-trend <0.001) in the derivation and validation cohorts, with C-indices of 0.87 (95% CI, 0.84–0.89) and 0.84 (0.81–0.86), respectively. Whereas there was no significant effect of dapagliflozin versus placebo on HHF in the low-risk group (hazard ratio [HR] 0.98 [95% CI 0.50–1.92]), dapagliflozin significantly reduced HHF in the intermediate-, high-, and very-high-risk groups (HR 0.64 [0.43–0.95], 0.63 [0.43–0.94], and 0.72 [0.54–0.96], respectively). Correspondingly, absolute risk reductions (95% CI) increased across these latter 3 groups: 1.0% (0.0–1.9), 3.0% (0.7–5.3), and 4.4% (−0.2 to 8.9) (P-trend <0.001). CONCLUSIONS We developed and validated a risk score for HHF in T2DM that incorporated NT-proBNP, prior HF, and hsTnT. The risk score identifies patients at higher risk of HHF who derive greater absolute benefit from dapagliflozin.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

Cited by 19 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3