• Eur. J. Intern. Med. · Aug 2019

    Multicenter Study

    External validation of the CACE-HF risk score for mortality in patients with heart failure.

    • R Quirós-López, L Manzano-Espinosa, A Bilbao, M Montero Pérez-Barquero, J M Cepeda-Rodrigo, and A Escobar-Martínez.
    • Internal Medicine Unit, Costa del Sol Hospital, Marbella, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; RICA Registry, Spain. Electronic address: quiroslopez77@gmail.com.
    • Eur. J. Intern. Med. 2019 Aug 1; 66: 35-40.

    AimsTo validate externally the CACE-HF clinical prediction rule, which predicts 1-year mortality in patients with heart failure (HF).MethodsWe performed an external validation of the CACE-HF risk score in patients included in the RICA heart failure registry who had completed 1 year of follow-up, comparing the characteristics of the derivation and validation cohorts. The performance of the risk score was evaluated in terms of calibration, using calibration-in-the-large (a), calibration slope (b), and the Hosmer-Lemeshow test, and in terms of discrimination, using the area under the ROC curve.ResultsIn total, 3337 patients were included in the validation cohort. There were no significant differences between the derivation and validation cohorts in 1-year mortality (24.63% vs. 22.98%) or in the risk score and risk classes. The discrimination capacity in the validation cohort was slightly lower, 0.67 (95% CI: 0.65, 0.69), compared to that of the derivation cohort. Calibration results were a -0.05 (95% CI: -0.14, 0.03), indicating that the average predictions did not differ from the average outcome frequency, and b = 0.75 (95% CI: 0.64, 0.86), indicating a modest inconsistency in predictor effects. Observed mortality versus predicted mortality according to the deciles and risk classes were very similar in both cases, indicating good calibration.ConclusionsThe results of the external validation of the CACE-HF risk score show that although the capacity for discrimination was slightly lower than in the derivation cohort, the calibration was excellent. This tool, therefore, can assist in decision-making in the management of these patients.Copyright © 2019 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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