TY - JOUR
T1 - Validation of the WATCH-DM and TRS-HFDM Risk Scores to Predict the Risk of Incident Hospitalization for Heart Failure Among Adults With Type 2 Diabetes
T2 - A Multicohort Analysis
AU - Segar, Matthew W.
AU - Patel, Kershaw V.
AU - Hellkamp, Anne S.
AU - Vaduganathan, Muthiah
AU - Lokhnygina, Yuliya
AU - Green, Jennifer B.
AU - Wan, Siu Hin
AU - Kolkailah, Ahmed A.
AU - Holman, Rury R.
AU - Peterson, Eric D.
AU - Kannan, Vaishnavi
AU - Willett, Duwayne L.
AU - McGuire, Darren K.
AU - Pandey, Ambarish
N1 - Funding Information:
The TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin) was funded by Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc, Kenilworth, NJ. Dr Vaduganathan is supported by the KL2/Catalyst Medical Research Investigator Training award from Harvard Catalyst (National Institutes of Health/National Center for Advancing Translational Sciences Award UL 1TR002541) and serves on advisory boards or has received research grant support from American Regent, Amgen, AstraZeneca, Baxter Healthcare, Bayer AG, Boehringer Ingelheim, Cytokinetics, and Relypsa. Dr Holman reports research support from AstraZeneca, Bayer, and Merck Sharp & Dohme, and personal fees from Anji Pharmaceuticals, AstraZeneca, Novartis, and Novo Nordisk. Dr. Kolkailah was supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number T32HL125247. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health. Dr McGuire 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, Boehringer Ingelheim, Lilly USA, Merck & Co, Inc, Pfizer, Novo Nordisk, Metavant, Afimmune, and Sanofi. Dr Pandey received grant funding outside the present study from Applied Therapeutics; has received honoraria outside of the present study as an advisor/consultant for Tricog Health Inc, Lilly, USA, Rivus, and Roche Diagnostics; and has received nonfinancial support from Pfizer and Merck. Dr Pandey is supported by the Texas Health Resources Clinical Scholarship, Gilead Sciences Research Scholar Program, the National Institute of Aging GEMSSTAR Grant (1R03AG067960-01), and grant support from Applied Therapeutics. Dr Peterson receives consulting from: advisory committees for Novo Nordisk, Novartis, Janssen, Pfizer, Bayer; and receives research support from: Janssen, Amgen, Esperion, BMS.
Funding Information:
The Look AHEAD (Look Action for Health in Diabetes) trial was conducted by the Look AHEAD Research Group and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); the National Heart, Lung, and Blood Institute; the National Institute of Nursing Research; the National Institute of Minority Health and Health Disparities; the Office of Research on Women’s Health; and the Centers for Disease Control and Prevention. The data (and samples) from Look AHEAD trial were supplied by the NIDDK Central Repository. This article was not prepared under the auspices of the Look AHEAD trial and does not represent analyses or conclusions of the Look AHEAD Research Group, the NIDDK Central Repository, or the National Institutes of Health.
Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2022/6/7
Y1 - 2022/6/7
N2 - BACKGROUND: The WATCH-DM (weight [body mass index], age, hypertension, creatinine, high-density lipoprotein cholesterol, diabetes control [fasting plasma glucose], ECG QRS duration, myocardial infarction, and coronary artery bypass grafting) and TRS-HFDM (Thrombolysis in Myocardial Infarction [TIMI] risk score for heart failure in diabetes) risk scores were developed to predict risk of heart failure (HF) among individuals with type 2 diabetes. WATCH-DM was developed to predict incident HF, whereas TRS-HFDM predicts HF hospitalization among patients with and without a prior HF history. We evaluated the model performance of both scores to predict incident HF events among patients with type 2 diabetes and no history of HF hospitalization across different cohorts and clinical settings with varying baseline risk. METHODS AND RESULTS: Incident HF risk was estimated by the integer-based WATCH-DM and TRS-HFDM scores in participants with type 2 diabetes free of baseline HF from 2 randomized clinical trials (TECOS [Trial Evaluating Cardiovascular Outcomes With Sitagliptin], N=12 028; and Look AHEAD [Look Action for Health in Diabetes] trial, N=4867). The integer-based WATCH-DM score was also validated in electronic health record data from a single large health care system (N=7475). Model discrimination was assessed by the Harrell concordance index and calibration by the Greenwood-Nam-D’Agostino statistic. HF incidence rate was 7.5, 3.9, and 4.1 per 1000 person-years in the TECOS, Look AHEAD trial, and electronic health record cohorts, respectively. Integer-based WATCH-DM and TRS-HFDM scores had similar discrimination and calibration for predicting 5-year HF risk in the Look AHEAD trial cohort (concordance indexes=0.70; Greenwood-Nam-D’Agostino P>0.30 for both). Both scores had lower discrimination and underpredicted HF risk in the TECOS cohort (concordance indexes=0.65 and 0.66, respectively; Greenwood-Nam-D’Agostino P<0.001 for both). In the electronic health record cohort, the integerbased WATCH-DM score demonstrated a concordance index of 0.73 with adequate calibration (Greenwood-Nam-D’Agostino P=0.96). TRS-HFDM score could not be validated in the electronic health record because of unavailability of data on urine albumin/creatinine ratio in most patients in the contemporary clinical practice. CONCLUSIONS: The WATCH-DM and TRS-HFDM risk scores can discriminate risk of HF among intermediate-risk populations with type 2 diabetes.
AB - BACKGROUND: The WATCH-DM (weight [body mass index], age, hypertension, creatinine, high-density lipoprotein cholesterol, diabetes control [fasting plasma glucose], ECG QRS duration, myocardial infarction, and coronary artery bypass grafting) and TRS-HFDM (Thrombolysis in Myocardial Infarction [TIMI] risk score for heart failure in diabetes) risk scores were developed to predict risk of heart failure (HF) among individuals with type 2 diabetes. WATCH-DM was developed to predict incident HF, whereas TRS-HFDM predicts HF hospitalization among patients with and without a prior HF history. We evaluated the model performance of both scores to predict incident HF events among patients with type 2 diabetes and no history of HF hospitalization across different cohorts and clinical settings with varying baseline risk. METHODS AND RESULTS: Incident HF risk was estimated by the integer-based WATCH-DM and TRS-HFDM scores in participants with type 2 diabetes free of baseline HF from 2 randomized clinical trials (TECOS [Trial Evaluating Cardiovascular Outcomes With Sitagliptin], N=12 028; and Look AHEAD [Look Action for Health in Diabetes] trial, N=4867). The integer-based WATCH-DM score was also validated in electronic health record data from a single large health care system (N=7475). Model discrimination was assessed by the Harrell concordance index and calibration by the Greenwood-Nam-D’Agostino statistic. HF incidence rate was 7.5, 3.9, and 4.1 per 1000 person-years in the TECOS, Look AHEAD trial, and electronic health record cohorts, respectively. Integer-based WATCH-DM and TRS-HFDM scores had similar discrimination and calibration for predicting 5-year HF risk in the Look AHEAD trial cohort (concordance indexes=0.70; Greenwood-Nam-D’Agostino P>0.30 for both). Both scores had lower discrimination and underpredicted HF risk in the TECOS cohort (concordance indexes=0.65 and 0.66, respectively; Greenwood-Nam-D’Agostino P<0.001 for both). In the electronic health record cohort, the integerbased WATCH-DM score demonstrated a concordance index of 0.73 with adequate calibration (Greenwood-Nam-D’Agostino P=0.96). TRS-HFDM score could not be validated in the electronic health record because of unavailability of data on urine albumin/creatinine ratio in most patients in the contemporary clinical practice. CONCLUSIONS: The WATCH-DM and TRS-HFDM risk scores can discriminate risk of HF among intermediate-risk populations with type 2 diabetes.
KW - diabetes
KW - heart failure
KW - risk prediction
KW - risk score
UR - http://www.scopus.com/inward/record.url?scp=85132286939&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132286939&partnerID=8YFLogxK
U2 - 10.1161/JAHA.121.024094
DO - 10.1161/JAHA.121.024094
M3 - Article
C2 - 35656988
AN - SCOPUS:85132286939
SN - 2047-9980
VL - 11
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e024094
ER -