@article{8d839a8b23bd46969323857f5e480646,
title = "Incorporation of natriuretic peptides with clinical risk scores to predict heart failure among individuals with dysglycaemia",
abstract = "AIMS: To evaluate the performance of the WATCH-DM risk score, a clinical risk score for heart failure (HF), in patients with dysglycaemia and in combination with natriuretic peptides (NPs).METHODS AND RESULTS: Adults with diabetes/pre-diabetes free of HF at baseline from four cohort studies (ARIC, CHS, FHS, and MESA) were included. The machine learning- [WATCH-DM(ml)] and integer-based [WATCH-DM(i)] scores were used to estimate the 5-year risk of incident HF. Discrimination was assessed by Harrell's concordance index (C-index) and calibration by the Greenwood-Nam-D'Agostino (GND) statistic. Improvement in model performance with the addition of NP levels was assessed by C-index and continuous net reclassification improvement (NRI). Of the 8938 participants included, 3554 (39.8%) had diabetes and 432 (4.8%) developed HF within 5 years. The WATCH-DM(ml) and WATCH-DM(i) scores demonstrated high discrimination for predicting HF risk among individuals with dysglycaemia (C-indices = 0.80 and 0.71, respectively), with no evidence of miscalibration (GND P ≥0.10). The C-index of elevated NP levels alone for predicting incident HF among individuals with dysglycaemia was significantly higher among participants with low/intermediate (<13) vs. high (≥13) WATCH-DM(i) scores [0.71 (95% confidence interval 0.68-0.74) vs. 0.64 (95% confidence interval 0.61-0.66)]. When NP levels were combined with the WATCH-DM(i) score, HF risk discrimination improvement and NRI varied across the spectrum of risk with greater improvement observed at low/intermediate risk [WATCH-DM(i) <13] vs. high risk [WATCH-DM(i) ≥13] (C-index = 0.73 vs. 0.71; NRI = 0.45 vs. 0.17).CONCLUSION: The WATCH-DM risk score can accurately predict incident HF risk in community-based individuals with dysglycaemia. The addition of NP levels is associated with greater improvement in the HF risk prediction performance among individuals with low/intermediate risk than those with high risk.",
keywords = "Adult, Cohort Studies, Glucose Metabolism Disorders/epidemiology, Heart Failure/diagnosis, Humans, Natriuretic Peptides, Risk Assessment/methods, Risk Factors",
author = "Segar, {Matthew W.} and Khan, {Muhammad Shahzeb} and Patel, {Kershaw V.} and Muthiah Vaduganathan and Vaishnavi Kannan and Duwayne Willett and Eric Peterson and Tang, {W. H.Wilson} and Javed Butler and Everett, {Brendan M.} and Fonarow, {Gregg C.} and Wang, {Thomas J.} and McGuire, {Darren K.} and Ambarish Pandey",
note = "Funding Information: M.W.S. has received non‐financial support from Pfizer and Merck. M.V. has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Roche Diagnostics, and Relypsa, and participates in clinical endpoint committees for studies sponsored by Galmed, Novartis, and participates in speaking engagements for Novartis and Roche Diagnostics. W.H.W.T. has consulted for Sequana Medical AG, Relypsa, PreCardia, CardiolRx Inc, and Owkin Inc., and served as exam writing committee member for American Board of Internal Medicine. B.M.E. has consulted for Amgen, Amarin, Gilead, Johnson & Johnson, Lily, Provention, Merck, Roche Diagnostics, American Heart Association, and UpToDate, and has grant support from PCORI, NHLBI, and Novo Nordisk. G.C.F. has consulted for Abbott, Amgen, Bayer, Cytokinetics, Edwards, Janssen, Medtronic, Merck, and Novartis. D.K.M. has had leadership roles in clinical trials for AstraZeneca, Boehringer Ingelheim, Eisai, Esperion, GlaxoSmithKline, Janssen, Lexicon, Merck & Co., Inc., Novo Nordisk, CSL Behring, and Sanofi USA; and has received consultancy fees from AstraZeneca, Bayer AG, Boehringer Ingelheim, Lilly USA, Merck & Co., Inc., Pfizer, Novo Nordisk, Metavant, Afimmune, and Sanofi. A.P. has served on the advisory board of Roche Diagnostics, has received non‐financial support from Pfizer and Merck, and has received research support from the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute on Aging GEMSSTAR Grant (1R03AG067960‐01), and Applied Therapeutics. J.B reports honoraria from Abbott, Adrenomed, Array, Amgen, Applied Therapeutics, Astra Zeneca, Bayer, Boehringer Ingelheim, CVRx, Eli Lilly, G3 Pharma, Imbria, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Sequana Medical, V‐Wave Limited, Vifor. All other authors have nothing to disclose. Conflict of interest: Funding Information: This study was supported by the Texas Health Resources Clinical Scholarship to Dr. Pandey. Funding Information: This study was supported by the Texas Health Resources Clinical Scholarship to Dr. Pandey. Conflict of interest: M.W.S. has received non-financial support from Pfizer and Merck. M.V. has received research grant support or served on advisory boards for American Regent, Amgen, AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, Lexicon Pharmaceuticals, Roche Diagnostics, and Relypsa, and participates in clinical endpoint committees for studies sponsored by Galmed, Novartis, and participates in speaking engagements for Novartis and Roche Diagnostics. W.H.W.T. has consulted for Sequana Medical AG, Relypsa, PreCardia, CardiolRx Inc, and Owkin Inc., and served as exam writing committee member for American Board of Internal Medicine. B.M.E. has consulted for Amgen, Amarin, Gilead, Johnson & Johnson, Lily, Provention, Merck, Roche Diagnostics, American Heart Association, and UpToDate, and has grant support from PCORI, NHLBI, and Novo Nordisk. G.C.F. has consulted for Abbott, Amgen, Bayer, Cytokinetics, Edwards, Janssen, Medtronic, Merck, and Novartis. D.K.M. has had leadership roles in clinical trials for AstraZeneca, Boehringer Ingelheim, Eisai, Esperion, GlaxoSmithKline, Janssen, Lexicon, Merck & Co., Inc., Novo Nordisk, CSL Behring, and Sanofi USA; and has received consultancy fees from AstraZeneca, Bayer AG, Boehringer Ingelheim, Lilly USA, Merck & Co., Inc., Pfizer, Novo Nordisk, Metavant, Afimmune, and Sanofi. A.P. has served on the advisory board of Roche Diagnostics, has received non-financial support from Pfizer and Merck, and has received research support from the Texas Health Resources Clinical Scholarship, the Gilead Sciences Research Scholar Program, the National Institute on Aging GEMSSTAR Grant (1R03AG067960-01), and Applied Therapeutics. J.B reports honoraria from Abbott, Adrenomed, Array, Amgen, Applied Therapeutics, Astra Zeneca, Bayer, Boehringer Ingelheim, CVRx, Eli Lilly, G3 Pharma, Imbria, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, Novo Nordisk, Relypsa, Sequana Medical, V-Wave Limited, Vifor. All other authors have nothing to disclose. Publisher Copyright: {\textcopyright} 2021 European Society of Cardiology.",
year = "2022",
month = jan,
doi = "10.1002/ejhf.2375",
language = "English (US)",
volume = "24",
pages = "169--180",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "1",
}