Novel risk score stratifies HHF risk in type 2 diabetes
medwireNews: Researchers have developed a novel clinical risk score for hospitalization for heart failure (HHF), which identifies people with type 2 diabetes most likely to benefit from sodium-glucose cotransporter 2 inhibition.
Marc Sabatine (Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA) and co-researchers say that the TIMI (Thrombolysis in Myocardial Infarction) Risk Score for Heart Failure in Diabetes (TRS-HFDM) is “a practical tool to assist clinicians with risk stratification, counseling, and therapeutic decision making in patients with [type 2 diabetes].”
Of 25 candidate HHF risk indicators selected on the basis of their prevalence, clinical relevance, and ease of access from the medical records of typical patients with type 2 diabetes, five independently predicted risk for HHF among a derivation cohort of 8212 placebo-treated people with type 2 diabetes in the SAVOR-TIMI 53 trial and were assigned a risk score.
Prior heart failure (2 points)Urinary albumin-to-creatinine ratio (>300 mg/g=2 points, 30–300 mg/g=1 point)History of atrial fibrillation (1 point)Coronary artery disease (1 point)Estimated glomerular filtration rate <60 mL/min per 1.73m2 (1 point)
The researchers report that “[t]his simple integer-based scheme” identified a strong and significant gradient in HHF risk, with incidence rates increasing from 1.9 cases per 1000 person–years among people with a score of 0 to 66.4 cases per 1000 person–years among those with a score of 4 or higher.
A similarly strong gradient was observed in a validation cohort of 8578 placebo-treated patients from the DECLARE-TIMI 58 trial, as well as in 8264 dapagliflozin-treated patients from the same trial.
Sabatine and co-investigators found that treatment with dapagliflozin versus placebo reduced the relative risk for HHF by a similar degree regardless of baseline TRS-HFDM score, with hazard ratios of 0.66, 0.74, 0.67, and 0.75, in people with scores of 0 (low risk), 1 (intermediate risk), 2 (high risk), and 3 or more (very high risk), respectively.
By contrast, the absolute reductions in HHF risk increased significantly with increasing baseline HHF risk, from 0.3% among those at low baseline risk to 0.6%, 1.5%, and 2.7%, among those at intermediate, high, and very high risk, respectively.
Furthermore, the researchers calculated that the numbers needed to treat to prevent one HHF at 4 years were 303, 172, 65, and 36 in the low, intermediate, high, and very high risk groups, respectively.
Writing in Circulation Sabatine et al say that their analysis “confirms that the relative risk reduction in HHF with sodium-glucose cotransporter-2 inhibitors is consistent regardless of baseline heart failure risk.”
They conclude, however, that “by using TRS-HFDM, a simple, validated clinical risk score for HHF, clinicians can better educate patients about their risk of HHF and identify those patients who have a greater absolute reduction in HHF risk with sodium-glucose cotransporter-2 inhibitors.”
By Laura Cowen
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