Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan

Toshiyuki Nagai, Varun Sundaram, Ahmad Shoaib, Yasuyuki Shiraishi, Shun Kohsaka, Kieran J. Rothnie, Susan Piper, Theresa A. Mcdonagh, Suzanna M.C. Hardman, Ayumi Goda, Atsushi Mizuno, Mitsuaki Sawano, Alan S. Rigby, Jennifer K. Quint, Tsutomu Yoshikawa, Andrew L. Clark, Toshihisa Anzai, John G.F. Cleland

Research output: Contribution to journalArticle

5 Citations (Scopus)

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 (∼77years). 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.

Original languageEnglish
JournalEuropean Journal of Heart Failure
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Japan
Heart Failure
Mortality
Calibration
United Kingdom
Hospital Mortality
Delivery of Health Care

Keywords

  • Acute heart failure
  • Hospitalized heart failure
  • Japan
  • Mortality prediction
  • Outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan. / Nagai, Toshiyuki; Sundaram, Varun; Shoaib, Ahmad; Shiraishi, Yasuyuki; Kohsaka, Shun; Rothnie, Kieran J.; Piper, Susan; Mcdonagh, Theresa A.; Hardman, Suzanna M.C.; Goda, Ayumi; Mizuno, Atsushi; Sawano, Mitsuaki; Rigby, Alan S.; Quint, Jennifer K.; Yoshikawa, Tsutomu; Clark, Andrew L.; Anzai, Toshihisa; Cleland, John G.F.

In: European Journal of Heart Failure, 01.01.2018.

Research output: Contribution to journalArticle

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 & 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. https://doi.org/10.1002/ejhf.1210
Nagai, Toshiyuki ; Sundaram, Varun ; Shoaib, Ahmad ; Shiraishi, Yasuyuki ; Kohsaka, Shun ; Rothnie, Kieran J. ; Piper, Susan ; Mcdonagh, Theresa A. ; Hardman, Suzanna M.C. ; Goda, Ayumi ; Mizuno, Atsushi ; Sawano, Mitsuaki ; Rigby, Alan S. ; Quint, Jennifer K. ; Yoshikawa, Tsutomu ; Clark, Andrew L. ; Anzai, Toshihisa ; Cleland, John G.F. / Validation of U.S. mortality prediction models for hospitalized heart failure in the United Kingdom and Japan. In: European Journal of Heart Failure. 2018.
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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 (∼77years). 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.",
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AU - Sundaram, Varun

AU - Shoaib, Ahmad

AU - Shiraishi, Yasuyuki

AU - Kohsaka, Shun

AU - Rothnie, Kieran J.

AU - Piper, Susan

AU - Mcdonagh, Theresa A.

AU - Hardman, Suzanna M.C.

AU - Goda, Ayumi

AU - Mizuno, Atsushi

AU - Sawano, Mitsuaki

AU - Rigby, Alan S.

AU - Quint, Jennifer K.

AU - Yoshikawa, Tsutomu

AU - Clark, Andrew L.

AU - Anzai, Toshihisa

AU - Cleland, John G.F.

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N2 - 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 (∼77years). 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.

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