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Publication Information

PubMed ID
Public Release Type
Journal
Publication Year
2022
Affiliation
1 Department of Cardiology, Texas Heart Institute, Houston, TX 2 Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 3 Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 4 Brigham and Women’s Hospital Heart and Vascular Center, Department of Medicine, Harvard Medical School, Boston, MA 5 Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 6 Diabetes Trials Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK 7 Parkland Health and Hospital System, Dallas, TX
Authors
Green JB, Hellkamp AS, Holman RR, Kannan V, Kolkailah AA, Lokhnygina Y, McGuire DK, Pandey A, Patel KV, Peterson ED, Segar MW, Vaduganathan M, Wan S, Willett D
Studies

Abstract

Background: The WATCH-DM and TRS-HFDM risk scores were developed to predict 5-year risk of incident heart failure (HF) among individuals with type 2 diabetes mellitus (T2DM). We externally validated both scores across different cohorts and clinical settings with varying baseline risk. Methods: Incident HF risk was estimated by the integer-based WATCH-DM(i) and TRS-HFDM scores in participants with T2DM free of baseline HF from two randomized clinical trials (TECOS, N=12,028 and Look AHEAD, N=4,867). The WATCH-DM(i) score was also validated in electronic health record (EHR) data from a single large healthcare system (N=7,475). Model discrimination was assessed by Harrell’s concordance index (C-index) and calibration by the Greenwood-Nam-D’Agostino (GND) statistic. Results: HF incidence rate was 7.5, 3.9, and 4.1 per 1000 person-years in the TECOS, Look AHEAD, and EHR cohorts, respectively. WATCH-DM(i) and TRS-HFDM scores had similar discrimination and calibration for predicting 5-year HF risk in the Look AHEAD cohort (C-indices = 0.70; GND p-value >0.30 for both). Both scores had lower discrimination and underpredicted HF risk in the TECOS cohort (C-indices = 0.65 and 0.62, respectively; GND p-value <0.001 for both). In the EHR cohort, the WATCH-DM(i) score demonstrated superior discrimination (C-index = 0.73) and no evidence of miscalibration (GND p-value = 0.96). Conclusions: The WATCH-DM and TRS-HFDM risk scores can discriminate risk of HF among intermediate-risk T2DM populations.