Comparison of predicted and observed mortality in patients with heart failure treated at a specialized unit

Abstract Introduction and objectives To analyze survival in heart failure (HF) patients treated at a specialized unit. Methods Prospective cohort-based study of HF patients treated at a specialized unit from 2011 to 2017. Observed 1- and 3-year mortality rates were compared with those predicted by the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score. Results We studied 1280 patients, whose median MAGGIC risk score was 19 [interquartile range, 13-24]. Prescription rates of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists, and sacubitril-valsartan were 93%, 67%, 22%, 73%, and 16%, respectively. The MAGGIC risk score showed good discrimination for mortality at 1 year (c-statistic = 0.71) and 3 years (c-statistic = 0.76). Observed mortality was significantly lower than predicted mortality, both at 1 year (6.2% vs 10.9%; observed/predicted ratio = 0.57; P  70 years (29.9% vs 34.7%; observed/predicted ratio = 0.86; P = .126) and in patients with ejection fraction > 40% (19.6% vs 20.7%; observed/predicted ratio = 0.95; P = .640). Conclusions Mortality in HF patients treated at a specialized clinic was significantly lower than that predicted by the MAGGIC risk score.