Development and Validation of a Risk Score for Predicting Death in Chagas' Heart Disease
Anis Rassi, Jr., M.D., Ph.D., Anis Rassi, M.D., William C. Little, M.D., Sérgio S. Xavier, M.D., Ph.D., Sérgio G. Rassi, M.D., Alexandre G. Rassi, M.D., Gustavo G. Rassi, M.D., Alejandro Hasslocher-Moreno, M.D., Andrea S. Sousa, M.D., Ph.D., and Maurício I. Scanavacca, M.D., Ph.D.
Background Chagas' disease is an important health problem inLatin America, and cardiac involvement is associated with substantialmorbidity and mortality. We developed a model to predict therisk of death in patients with Chagas' heart disease.
Methods We retrospectively evaluated 424 outpatients from aregional Brazilian cohort. The association of potential riskfactors with death was tested by Cox proportional-hazards analysis,and a risk score was created. The model was validated in 153patients from a separate community hospital.
Results During a mean follow-up of 7.9 years, 130 patients inthe development cohort died. Six independent prognostic factorswere identified, and each was assigned a number of points proportionalto its regression coefficient: New York Heart Association classIII or IV (5 points), evidence of cardiomegaly on radiography(5 points), left ventricular systolic dysfunction on echocardiography(3 points), nonsustained ventricular tachycardia on 24-hourHolter monitoring (3 points), low QRS voltage on electrocardiography(2 points), and male sex (2 points). We calculated risk scoresfor each patient and defined three risk groups: low risk (0to 6 points), intermediate risk (7 to 11 points), and high risk(12 to 20 points). In the development cohort, the 10-year mortalityrates for these three groups were 10 percent, 44 percent, and84 percent, respectively. In the validation cohort, the correspondingmortality rates were 9 percent, 37 percent, and 85 percent.The C statistic for the point system was 0.84 in the developmentcohort and 0.81 in the validation cohort.
Conclusions A simple risk score was developed to predict deathin Chagas' heart disease and was validated in an independentcohort.
Source Information
From the Division of Cardiology, Anis Rassi Hospital, Goiânia, Brazil (A.R. Jr., A.R., S.G.R., A.G.R., G.G.R.); the Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, N.C. (W.C.L.); the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro (S.S.X., A.H.-M., A.S.S.); and the Instituto do Coração, University of São Paulo Medical School, São Paulo (M.I.S.).
Address reprint requests to Dr. Anis Rassi, Jr., at the Division of Cardiology, Anis Rassi Hospital, Avenida José Alves 453, Setor Oeste, Goiânia, GO, Brazil, 74.110-020, or at arassijr{at}arh.com.br.
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