The clinical utility of the HFA–ICOS risk proforma for predicting heart failure hospitalization in a real-world cohort of multiple myeloma patients

Real-life data on cardiovascular (CV) risk stratification among multiple myeloma (MM) patients is scarce. This study aims to evaluate the utility of the CV risk stratification proforma by the Heart Failure Association (HFA) of the European Society of Cardiology and the International Cardio-Oncology Society (ICOS) in predicting heart failure hospitalization (HFH) and CV mortality in MM patients. A total of 419 consecutive MM patients receiving proteasome inhibitors or immunomodulating agents at Queen Elizabeth Hospital, Hong Kong between 2012 and 2023 (mean age 68 ± 11 years, 52.5% male) were recruited. Data pertaining to comorbidities, medications, laboratory tests and CV events were retrieved through electronic medical system. Patients were stratified into low-risk (n = 184), medium-risk (n = 150), and combined high/very-high-risk (n = 85) groups using the HFA-ICOS CV risk proforma. Statistical analyses with log-rank tests, multivariable Cox regression and receiver operating characteristic analysis were done with R v.4.4.3 and SPSS 29 to assess the role of individual risk factor and the risk proforma. After a median follow-up of 35 months (IQR 17–63), the 3-year cumulative incidences of HFH were 4.3% in the low-risk group, 11.1% in the medium-risk group, and 28.3% in the high-/very-high-risk group (log-rank p < 0.001). The 3-year cumulative incidences of CV mortality were 1.4%, 5.1%, and 11.8%, respectively, with a trend toward increased risk across groups (log-rank p = 0.084). Multivariable Fine-Gray subdistribution hazard model identified advanced age (SHR: 1.03; 95% CI: 1.01–1.08; p = 0.024), prior heart failure (SHR: 3.96; 95% CI: 1.90–8.24; p < 0.001), atrial fibrillation (SHR: 2.30; 95% CI: 1.01–5.24; p = 0.048) and chronic kidney disease (SHR: 4.34; 95% CI: 2.22–8.48; p < 0.001) as most significant predictors of HFH. Comparing with low-risk group, medium-risk group patients had significantly increased incidence of HFH (SHR: 2.29; 95% CI: 1.02–5.18; p = 0.045). Likewise, high-/very-high-risk group showed higher incidence of HFH (SHR: 6.39; 95% CI: 2.99–13.67; p < 0.001). The C-statistic of the risk proforma was 0.706 (95% CI: 0.63–0.78; p < 0.001). The HFA-ICOS risk proforma demonstrated significant role in identifying MM patients at risk for HFH in a real-world setting.