Prediction of heart failure outcomes in patients with type 2 diabetes mellitus: Validation of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HF_DM ) in patients in the ACCORD trial

Aim: To investigate the ability of the Thrombolysis in Myocardial Infarction Risk Score for Heart Failure in Diabetes (TRS-HF_DM ) to stratify patients with type 2 diabetes mellitus (T2DM) and high cardiovascular risk for heart failure (HF) hospitalization.

Materials and methods: We used data from the control group of the Action to Control Cardiovascular Risk in Diabetes Study Group (ACCORD) trial (n = 5123; mean follow-up 4.8 years). The TRS-HF_DM includes: prior HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 mL/min/1.73 m² (1 point), and urine albumin-to-creatinine ratio (>300 mg/g: 2 points; 30-300 mg/g: 1 point). We evaluated the discrimination (Harrell's C-index) and calibration (Nam-D'Agostino calibration statistic) of the TRS-HF_DM with regard to time to HF hospitalization or death due to HF.

Results: The mean age of the participants was 62.8 ± 6.6 years, and 38% were women. The prevalences of TRS-HF_DM 0, 1, 2, 3 and ≥4 were 42.1%, 34.9%, 14.6%, 6.0% and 2.5%, respectively. Increasing TRS-HF_DM corresponded to an increasing HF risk: 1.3 per 1000 person-years for a TRS-HF_DM of 0 to 64.7 per 1000 person-years for TRS-HF_DM of ≥4. The TRS-HF_DM demonstrated robust discrimination of HF outcomes (C-index 0.78). Furthermore, the score was well calibrated for HF outcomes (calibration statistic P = 0.13). Similar results were seen in participants without baseline HF (C-index 0.75).

Conclusion: The TRS-HF_DM discriminates HF-specific risk among people with T2DM. The use of TRS-HF_DM to identify those who would maximally benefit from therapies that reduce HF risk warrants evaluation.