| Title: |
Prediction of incident heart failure in established atherosclerotic cardiovascular disease: the SMART2-HF model |
| Authors: |
Reitsma, Tessa H; Lim, Carl-Emil; Gynnild, Mari N; Kaptoge, Stephen; Lõo, Laura; Holtrop, Joris; Kuźma, Łukasz; Pennells, Lisa; Conrad, Nathalie; Ueda, Peter; Jernberg, Tomas; Kurasz, Anna; Keene, Spencer J; Chilala, Chimweta; Deo, Salil V; Tillmann, Taavi; Khunti, Kamlesh; Piepoli, Massimo; Rossello, Xavier; Savarese, Gianluigi; Dalen, Håvard; Steg, Ph Gabriel; Wood, Angela M; Lees, Jennifer S; Kavousi, Maryam; McEvoy, John William; de Boer, Rudolf A; Andersson, Charlotte; Bhatt, Deepak L; Visseren, Frank L J; Dorresteijn, Jannick A N; Koudstaal, Stefan; Di Angelantonio, Emanuele; Hageman, Steven H J; Bongers, S I M; van Giele, J L P; Van Daal, M; Cramer, M J; van der Meer, M G; van der Harst, P; Nathoe, H M; van Setten, J; Teraa, M; Onland-Moret, N C; Van Smeden, M; Emmelot-Vonk, M H; de Jong, P A; Lely, A T; Haitjema, S; Mokhles, M M |
| Source: |
European Heart Journal ; ISSN 0195-668X 1522-9645 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2026 |
| Description: |
Background and aims Patients with established atherosclerotic cardiovascular disease (ASCVD) are at high risk of developing heart failure (HF). However, incident HF is not part of the risk assessment of current guideline-recommended models. The aim of this study was to develop and externally validate the SMART2-HF model for prediction of incident HF in patients with ASCVD. Methods SMART2-HF was developed in 7698 individuals with established ASCVD (coronary, cerebrovascular, or peripheral artery disease, or abdominal aortic aneurysm) but without prior HF from the UCC-SMART cohort. Cox proportional hazards models including sex-predictor interactions and with age as the time scale were derived to estimate the 10-year and lifetime risk of incident HF (hospitalization for HF or HF-related death), accounting for competing non-HF mortality. Predictors, limited to routinely available clinical characteristics, were aligned with the SMART2 risk model for recurrent cardiovascular risk in the same population. External validation was performed in 240 741 patients with ASCVD from six data sources: the Clinical Practice Research Datalink, the HUNT3 study, the SWEDEHEART Registry, the ASCVD-Particles cohort, the Estonian Biobank and the international REACH Registry. Results During a median follow-up of 11.2 years (interquartile range 6.1–16.4 years), 1031 incident HF events (13%) occurred in the UCC-SMART cohort. In the external validation data sources, a total of 24 885 incident HF events (10%) occurred. The pooled C-statistic was 0.696 (95% confidence interval 0.674–0.717), with consistent performance in subgroups by sex and type of ASCVD. Predicted risks matched observed incidence in external validation. Conclusions The SMART2-HF model enables the prediction of incident HF in patients with ASCVD. Aligned with the guideline-recommended SMART2 model for recurrent cardiovascular risk, SMART2-HF can be used as a complementary tool in this population. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/eurheartj/ehag153 |
| DOI: |
10.1093/eurheartj/ehag153/67283405/ehag153.pdf |
| Availability: |
https://doi.org/10.1093/eurheartj/ehag153; https://academic.oup.com/eurheartj/advance-article-pdf/doi/10.1093/eurheartj/ehag153/67283405/ehag153.pdf |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ |
| Accession Number: |
edsbas.39A5D888 |
| Database: |
BASE |