Pub Date : 2026-03-11DOI: 10.1093/eurheartj/ehag182
Tessa H Reitsma,Gianluigi Savarese,Łukasz Kuźma,Salil V Deo,Lisa Pennells,Steven H J Hageman,Joris Holtrop,Lina Benson,Nathalie Conrad,Lars H Lund,Anna Kurasz,Stephen Kaptoge,Spencer J Keene,Chimweta Chilala,Matilda Pitt,Robert A Fletcher,Kamlesh Khunti,Massimo Piepoli,Xavier Rossello,Jennifer S Lees,Maryam Kavousi,John William McEvoy,Angela M Wood,Rudolf A de Boer,Charlotte Andersson,Frank L J Visseren,Stefan Koudstaal,Emanuele Di Angelantonio,Jannick A N Dorresteijn,
BACKGROUND AND AIMSHeart failure (HF) with preserved ejection fraction (HFpEF) constitutes a heterogeneous disease with varying prognosis. Given the rising incidence of HFpEF, accurate risk prediction for these patients is needed to identify high-risk individuals, who may benefit the most from preventive treatments. The LIFE-Preserved model was developed and validated for the prediction of individual short-term and lifetime risk for HF hospitalization or cardiovascular (CV) death in patients with HFpEF.METHODSLIFE-Preserved was derived in 20,332 patients aged 40-90 years with a left ventricular ejection fraction ≥50% from the Swedish HF Registry (SwedeHF). Cause- and sex-specific Cox models were derived to predict the risk of HF hospitalization or CV death using 14 routinely available predictors. Use of age as the timescale allowed for predictions beyond the maximum follow-up duration in the derivation data, adjusted for competing risks. External validation was performed in two trials (EMPEROR-Preserved, TOPCAT-Americas) and three registries (NHS England Secure Data Environment, Veterans Affairs, HF-Particles). Model performance was assessed by discrimination and calibration.RESULTSDuring a median follow-up of 1.8 years (interquartile range 0.6-4.2, maximum 19 years), 9341 first HF hospitalizations or CV deaths (46%) were observed in SwedeHF. External validation included data from 28 062 patients with HFpEF (9930 [35%] first HF hospitalizations or CV deaths). Pooled C-statistics were 0.714 (95% confidence interval [CI] 0.652-0.775) in trials and 0.658 (95% CI 0.599-0.717) in registries, with adequate calibration in all external validation sources. Performance was similar in men and women. An interactive calculator of the LIFE-Preserved model has been made available here.CONCLUSIONSThe LIFE-Preserved model enables prediction of short-term and lifetime risk of HF hospitalization or CV death in patients with HFpEF. The model could serve as a tool to identify high-risk HFpEF patients, guiding clinical management and shared decision-making.
背景和目的：保留射血分数（HFpEF）的心力衰竭（HF）是一种具有不同预后的异质性疾病。鉴于HFpEF的发病率不断上升，需要对这些患者进行准确的风险预测，以识别可能从预防性治疗中获益最多的高危个体。开发并验证了LIFE-Preserved模型，用于预测HFpEF患者HF住院或心血管（CV）死亡的个体短期和终生风险。方法从瑞典HF登记处（SwedeHF）的20,332例40-90岁左室射血分数≥50%的患者中获得slife - preserved。采用14种常规预测因子，建立了病因和性别特异性Cox模型来预测HF住院或CV死亡的风险。使用年龄作为时间尺度，可以在推导数据中进行超过最长随访时间的预测，并根据相互竞争的风险进行调整。在两个试验（emperr - preserved, TOPCAT-Americas）和三个注册中心（NHS England Secure Data Environment, Veterans Affairs, HF-Particles）中进行了外部验证。通过判别和校准来评估模型的性能。结果在中位1.8年的随访期间（四分位数范围0.6-4.2，最长19年），在瑞典HF观察到9341例首次HF住院或CV死亡（46%）。外部验证包括28062例HFpEF患者的数据（9930例[35%]首次HF住院或CV死亡）。试验的合并c统计量为0.714(95%置信区间[CI] 0.652-0.775)，注册中心的合并c统计量为0.658(95%置信区间[CI] 0.599-0.717)，所有外部验证源均进行了适当的校准。男性和女性的表现相似。保存生命模型的交互式计算器已在这里提供。结论：LIFE-Preserved模型能够预测HFpEF患者HF住院或CV死亡的短期和终生风险。该模型可作为识别HFpEF高危患者、指导临床管理和共同决策的工具。
{"title":"Risk prediction in patients with heart failure with preserved ejection fraction: the LIFE-Preserved model.","authors":"Tessa H Reitsma,Gianluigi Savarese,Łukasz Kuźma,Salil V Deo,Lisa Pennells,Steven H J Hageman,Joris Holtrop,Lina Benson,Nathalie Conrad,Lars H Lund,Anna Kurasz,Stephen Kaptoge,Spencer J Keene,Chimweta Chilala,Matilda Pitt,Robert A Fletcher,Kamlesh Khunti,Massimo Piepoli,Xavier Rossello,Jennifer S Lees,Maryam Kavousi,John William McEvoy,Angela M Wood,Rudolf A de Boer,Charlotte Andersson,Frank L J Visseren,Stefan Koudstaal,Emanuele Di Angelantonio,Jannick A N Dorresteijn, ","doi":"10.1093/eurheartj/ehag182","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag182","url":null,"abstract":"BACKGROUND AND AIMSHeart failure (HF) with preserved ejection fraction (HFpEF) constitutes a heterogeneous disease with varying prognosis. Given the rising incidence of HFpEF, accurate risk prediction for these patients is needed to identify high-risk individuals, who may benefit the most from preventive treatments. The LIFE-Preserved model was developed and validated for the prediction of individual short-term and lifetime risk for HF hospitalization or cardiovascular (CV) death in patients with HFpEF.METHODSLIFE-Preserved was derived in 20,332 patients aged 40-90 years with a left ventricular ejection fraction ≥50% from the Swedish HF Registry (SwedeHF). Cause- and sex-specific Cox models were derived to predict the risk of HF hospitalization or CV death using 14 routinely available predictors. Use of age as the timescale allowed for predictions beyond the maximum follow-up duration in the derivation data, adjusted for competing risks. External validation was performed in two trials (EMPEROR-Preserved, TOPCAT-Americas) and three registries (NHS England Secure Data Environment, Veterans Affairs, HF-Particles). Model performance was assessed by discrimination and calibration.RESULTSDuring a median follow-up of 1.8 years (interquartile range 0.6-4.2, maximum 19 years), 9341 first HF hospitalizations or CV deaths (46%) were observed in SwedeHF. External validation included data from 28 062 patients with HFpEF (9930 [35%] first HF hospitalizations or CV deaths). Pooled C-statistics were 0.714 (95% confidence interval [CI] 0.652-0.775) in trials and 0.658 (95% CI 0.599-0.717) in registries, with adequate calibration in all external validation sources. Performance was similar in men and women. An interactive calculator of the LIFE-Preserved model has been made available here.CONCLUSIONSThe LIFE-Preserved model enables prediction of short-term and lifetime risk of HF hospitalization or CV death in patients with HFpEF. The model could serve as a tool to identify high-risk HFpEF patients, guiding clinical management and shared decision-making.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"1 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1093/eurheartj/ehag183
Christian Torp-Pedersen,Kristian Hay Kragholm,Lars Køber
{"title":"Risk Scores for Heart Failure: Powerful for Populations, Problematic for the individual Patient.","authors":"Christian Torp-Pedersen,Kristian Hay Kragholm,Lars Køber","doi":"10.1093/eurheartj/ehag183","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag183","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"33 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1093/eurheartj/ehag190
{"title":"Correction to: Transcatheter edge-to-edge repair vs medical therapy in atrial functional mitral regurgitation: a propensity score-based comparison from the OCEAN-Mitral and REVEAL-AFMR registries.","authors":"","doi":"10.1093/eurheartj/ehag190","DOIUrl":"10.1093/eurheartj/ehag190","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":""},"PeriodicalIF":35.6,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1093/eurheartj/ehag153
Tessa H Reitsma,Carl-Emil Lim,Mari N Gynnild,Stephen Kaptoge,Laura Lõo,Joris Holtrop,Łukasz Kuźma,Lisa Pennells,Nathalie Conrad,Peter Ueda,Tomas Jernberg,Anna Kurasz,Spencer J Keene,Chimweta Chilala,Salil V Deo,Taavi Tillmann,Kamlesh Khunti,Massimo Piepoli,Xavier Rossello,Gianluigi Savarese,Håvard Dalen,Ph Gabriel Steg,Angela M Wood,Jennifer S Lees,Maryam Kavousi,John William McEvoy,Rudolf A de Boer,Charlotte Andersson,Deepak L Bhatt,Frank L J Visseren,Jannick A N Dorresteijn,Stefan Koudstaal,Emanuele Di Angelantonio,Steven H J Hageman, ,
BACKGROUND AND AIMSPatients 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.METHODSSMART2-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.RESULTSDuring 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.CONCLUSIONSThe 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.
{"title":"Prediction of incident heart failure in established atherosclerotic cardiovascular disease: the SMART2-HF model.","authors":"Tessa H Reitsma,Carl-Emil Lim,Mari N Gynnild,Stephen Kaptoge,Laura Lõo,Joris Holtrop,Łukasz Kuźma,Lisa Pennells,Nathalie Conrad,Peter Ueda,Tomas Jernberg,Anna Kurasz,Spencer J Keene,Chimweta Chilala,Salil V Deo,Taavi Tillmann,Kamlesh Khunti,Massimo Piepoli,Xavier Rossello,Gianluigi Savarese,Håvard Dalen,Ph Gabriel Steg,Angela M Wood,Jennifer S Lees,Maryam Kavousi,John William McEvoy,Rudolf A de Boer,Charlotte Andersson,Deepak L Bhatt,Frank L J Visseren,Jannick A N Dorresteijn,Stefan Koudstaal,Emanuele Di Angelantonio,Steven H J Hageman, , ","doi":"10.1093/eurheartj/ehag153","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag153","url":null,"abstract":"BACKGROUND AND AIMSPatients 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.METHODSSMART2-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.RESULTSDuring 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.CONCLUSIONSThe 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.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"70 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-11DOI: 10.1093/eurheartj/ehag154
,
BACKGROUND AND AIMSHeart failure (HF) presents a significant and growing public health challenge. The aim of this study was to develop and validate SCORE2-HF, a model for HF risk estimation in European adults aged over 40-years without previous cardiovascular disease.METHODSUsing data from 25 prospective cohorts (14 countries, 611 778 individuals, 21 818 incident HF events) the sex-specific, competing risk-adjusted SCORE2-HF models were derived including age, smoking status, systolic blood pressure, antihypertensive treatment, body mass-index (BMI), estimated glomerular filtration rate, and type 2 diabetes mellitus (T2DM), including age at diagnosis and glycated haemoglobin. Using Europe-wide statistics from the World Health Organization and linked health records from five countries (>36 million individuals, 515 466 incident HF events) models were recalibrated to contemporary 10-year and 30-year HF incidence in four European risk regions. SCORE2-HF was validated using data from three further cohorts (three countries; 1 336 824 participants; 36 841 incident HF-events).RESULTSIn the three external validation cohorts, C-indices (95% confidence interval) were 0.827 (0.824-0.829), 0.839 (0.827-0.850) and 0.874 (0.863-0.884). SCORE2-HF risks varied importantly by individual's risk factors, and risk region. For example, in the low-risk region, the average 10-year risk for 70-year-old individuals with zero versus four adverse risk factors (smoking, T2DM, hypertension and BMI >30 kg/m2), was 8% versus 24% in men and 6% versus 20% in women. By contrast, in the very high-risk region, average SCORE2-HF risk with four adverse risk factors was 59% in 70-year-old men or women.CONCLUSIONSSCORE2-HF - a model derived, recalibrated and validated to estimate 10-year and 30-year risk of incident HF across European countries - may enhance the identification of individuals at higher risk of developing HF.
{"title":"Prediction of incident heart failure in individuals without prior cardiovascular disease: the SCORE2-HF risk model.","authors":" , ","doi":"10.1093/eurheartj/ehag154","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag154","url":null,"abstract":"BACKGROUND AND AIMSHeart failure (HF) presents a significant and growing public health challenge. The aim of this study was to develop and validate SCORE2-HF, a model for HF risk estimation in European adults aged over 40-years without previous cardiovascular disease.METHODSUsing data from 25 prospective cohorts (14 countries, 611 778 individuals, 21 818 incident HF events) the sex-specific, competing risk-adjusted SCORE2-HF models were derived including age, smoking status, systolic blood pressure, antihypertensive treatment, body mass-index (BMI), estimated glomerular filtration rate, and type 2 diabetes mellitus (T2DM), including age at diagnosis and glycated haemoglobin. Using Europe-wide statistics from the World Health Organization and linked health records from five countries (>36 million individuals, 515 466 incident HF events) models were recalibrated to contemporary 10-year and 30-year HF incidence in four European risk regions. SCORE2-HF was validated using data from three further cohorts (three countries; 1 336 824 participants; 36 841 incident HF-events).RESULTSIn the three external validation cohorts, C-indices (95% confidence interval) were 0.827 (0.824-0.829), 0.839 (0.827-0.850) and 0.874 (0.863-0.884). SCORE2-HF risks varied importantly by individual's risk factors, and risk region. For example, in the low-risk region, the average 10-year risk for 70-year-old individuals with zero versus four adverse risk factors (smoking, T2DM, hypertension and BMI >30 kg/m2), was 8% versus 24% in men and 6% versus 20% in women. By contrast, in the very high-risk region, average SCORE2-HF risk with four adverse risk factors was 59% in 70-year-old men or women.CONCLUSIONSSCORE2-HF - a model derived, recalibrated and validated to estimate 10-year and 30-year risk of incident HF across European countries - may enhance the identification of individuals at higher risk of developing HF.","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"72 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-09DOI: 10.1093/eurheartj/ehag158
Hasan Mohiaddin,Mamas A Mamas,Muhammad Rashid
{"title":"The biological reality of frailty in the young.","authors":"Hasan Mohiaddin,Mamas A Mamas,Muhammad Rashid","doi":"10.1093/eurheartj/ehag158","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag158","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"5 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147374108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-09DOI: 10.1093/eurheartj/ehaf618
Liesl Zühlke, Maria Rubini, Roxana Mehran
{"title":"Building a leadership pipeline through professional development.","authors":"Liesl Zühlke, Maria Rubini, Roxana Mehran","doi":"10.1093/eurheartj/ehaf618","DOIUrl":"10.1093/eurheartj/ehaf618","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"1137-1138"},"PeriodicalIF":35.6,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145932765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-09DOI: 10.1093/eurheartj/ehag157
Miyuan Wang
{"title":"Beyond relative risk: a deeper look at frailty in younger AMI patients.","authors":"Miyuan Wang","doi":"10.1093/eurheartj/ehag157","DOIUrl":"https://doi.org/10.1093/eurheartj/ehag157","url":null,"abstract":"","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":"58 1","pages":""},"PeriodicalIF":39.3,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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