Prediction of incident heart failure in individuals without prior cardiovascular disease: the SCORE2-HF risk model.

BACKGROUND AND AIMS: Heart 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. METHODS: Using 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). RESULTS: In 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. CONCLUSIONS: SCORE2-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.