An Effective Risk Calculator for Patients With Heart Failure

A right ventricular failure (RVF) risk calculator called STOP-RVF can be used as a personalized assessment tool for the prevention of heart failure-associated mortality, according to a recent study published in JAMA Cardiology.

“The existing models predicting RVF after durable [left ventricular assist device (LVAD)] support might be limited, partly due to lack of external validation, marginal predictive power, and the absence of intraoperative characteristics,” the investigators wrote.

In their hybrid, prospective-retrospective, multicenter, cohort study, researchers assessed 798 patients with advanced heart failure requiring continuous-flow LVAD enrolled at 5 institutions. The primary end point of interest was RVF incidence, defined as the need for an RVF assist device or intravenous inotropes for longer than 14 days. STOP-RVF was then developed and validated to provide personalized quantification of the risk for LVAD candidates.

During the study, RVF developed in 24.2% of patients in the derivation cohort and 32.7% of those in the validation cohort. Variables associated with postoperative RVF included nonischemic cardiomyopathy, intra-aortic balloon pump, microaxial percutaneous LVAD/venoarterial extracorporeal membrane oxygenation, LVAD configuration, an Interagency Registry for Mechanically Assisted Circulatory Support profile of 1 to 2, right atrial/pulmonary capillary wedge pressure ratio, use of angiotensin-converting enzyme inhibitors, platelet count, and serum sodium, albumin, and creatinine levels.

The researchers noted that this calculator achieved a C statistic of 0.75 (95% CI, 0.71-0.79) in the derivation cohort and 0.73 (95% CI, 0.67-0.80) in the validation cohort, with a cumulative survival score that was higher in patients comprising the low-risk group compared with those in the higher-risk groups. “Implementing routine clinical data, this multicenter, cohort study derived and validated the STOP-RVF calculator as a personalized risk assessment tool for the prediction of RVF and RVF-associated all-cause mortality.”