Risk calculator of multimorbid risk of rehospitalization and death from heart failure: including the contribution of the gut microbiome

The contributory role of multimorbidity is not well understood in heart failure (HF), including the more recent addition of the gut microbiome (gut-heart axis). However, in current HF risk scores, the contributory role of multimorbidity is seldom considered. In this study, we developed an 11-variable risk model and a simple risk score calculator for clinical use that considers the contribution of HF multimorbidity, including the gut microbiome. The clinical risk score was developed and validated in a clinical cohort from two combined independent European studies from inpatient heart failure subjects. The outcomes were death due to HF and/or rehospitalization at 1 year. The final model showed diagnostic performance comparable to current HF risk scores. Furthermore, the risk score calculator, developed for clinical use, is able to stratify patients into low-, mid-, and high-risk groups, with worsening outcomes seen with increasing risk group. The importance and novelty of this risk model over current HF risk scores are the contribution of comorbidities including the added value of the gut-heart axis on HF risk stratification.