The Risk Estimation by the PREVENT equations and Clinical Outcome in Patients with Heart Failure with Preserved Ejection Fraction.

Background: The PREVENT (Predicting Risk of CVD EVENTs) equations estimate the risk of incident cardiovascular disease (CVD) in primary prevention patients. We hypothesized that risk factors incorporated in the equations may be relevant to prognosis in heart failure (HF) and investigated the association between estimated CVD risk and clinical outcomes in patients with preserved ejection fraction (HFpEF). Methods: We estimated the 10-year CVD risk using the PREVENT equations in 278 patients hospitalized for acutely decompensated HFpEF (median 75 years, 51.4% male). We divided them into four groups according to the quartiles of estimated CVD risk and followed them to observe major adverse cardiovascular events (MACE), a composite of all-cause death, HF hospitalization, and stroke. Results: MACE occurred in 125 patients (45.0%) over a median follow-up of 1,050 days. The estimated CVD risk classification was an independent predictor for MACE (p=0.02) in the multivariable Cox proportional hazard model. There was a difference in MACE-free survival across the four quartile groups (p<0.001 by log-rank test), and the lowest CVD risk group had significantly lower MACE incidence than other groups. The estimated CVD risk provided incremental prognostic value beyond N-terminal pro-B type natriuretic peptide (C-index: 0.626 vs, P=0.009). The predictive value of the estimated CVD risk for MACE at 1 year was comparable to that of the MAGGIC score (AUC 0.676 vs. 0.639, p=0.42). Conclusions: The 10-year CVD risk estimated by the PREVENT equations had a moderate predictive value for MACE in patients hospitalized for HFpEF.