Prediction of worsening heart failure events and all-cause mortality using an individualized risk stratification strategy.

Aims: This study aimed to examine the clinical utility of a multisensor, remote, ambulatory diagnostic risk score, TriageHF™, in a real-world, unselected, large patient sample to predict heart failure events (HFEs) and all-cause mortality.

Methods And Results: TriageHF risk score was calculated in patients in the Optum database who had Medtronic implantable cardiac defibrillator device from 2007 to 2016. Patients were categorized into three risk groups based on probability for having an HFE within 6 months (low risk <5.4%, medium risk ≥5.4 < 20%, and high risk ≥20%). Data were analysed using three strategies: (i) scheduled monthly data download; (ii) alert-triggered data download; and (iii) daily data download. Study population consisted of 22 901 patients followed for 1.8 ± 1.3 years. Using monthly downloads, HFE risk over 30 days incrementally increased across risk categories (odds ratio: 2.8, 95% confidence interval: 2.5-3.2 for HFE, P < 0.001, low vs. medium risk, and odds ratio: 9.2, 95% confidence interval: 8.1-10.3, P < 0.001, medium vs. high risk). Findings were similar using the other two analytic strategies. Using a receiver operating characteristic curve analysis, sensitivity for predicting HFE over 30 days using high-risk score was 47% (alert triggered) and 51% (daily download) vs. 0.5 per patient year unexplained detection rate. TriageHF risk score also predicted all-cause mortality risk over 4 years. All-cause mortality risk was 14% in low risk, 20% in medium risk, and 38% in high risk.

Conclusions: TriageHF risk score provides a multisensor remote, ambulatory diagnostic method that predicts both HFEs and all-cause mortality.