A Simple Clinical Risk Score to Improve Prediction of Anthracycline-Induced Cardiotoxicity
Authors' conclusion
HFA-ICOS score effectively stratifies baseline risk, while the RE-ACT score provides additional post-treatment prognostic value.
Study context
- Population
- Adult cancer patients with baseline left ventricular ejection fraction (LVEF) ≥50% treated with anthracyclinesexternal validation n = 819
- Participants
- 2,612 patients
- Exposure
- RE-ACT score vs Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) score
- Outcome
- Cardiotoxicity (LVEF decrease >10 percentage points to <50% or HF)
- Follow-up
- 1 year
Methodological detailsrisk score development and validation, cross-validation, external validation cohort
- Risk score development and validation
- Cross-validation
- External validation cohort
Main finding
As reported in the abstract
Discrimination for cardiotoxicity (AUC)
| Group | AUC |
|---|---|
| HFA-ICOS | 0.76 (95% CI: 0.67-0.86) |
| RE-ACT | 0.83 (95% CI: 0.74-0.93) |
| Combined | 0.87 (95% CI: 0.80-0.95) |
AUC
HFA-ICOS0.76 (95% CI: 0.67-0.86)
RE-ACT0.83 (95% CI: 0.74-0.93)
Combined0.87 (95% CI: 0.80-0.95)
- Combined vs HFA-ICOS: P < 0.001 — derivation cohort
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Cardiotoxicity by HFA-ICOS risk category vs low risk · first 2 yearsModerate riskvs Low risk | 1.44 (1.02–2.06) | |
| Cardiotoxicity by HFA-ICOS risk category vs low risk · first 2 yearsHigh riskvs Low risk | 1.84 (1.36–2.50) | |
| 0.512Hazard ratio (log scale) |
- RE-ACT AUC in validation cohort · 1 year
- 0.88 (95% CI: 0.80-0.95) · AUC
Cumulative incidence of cardiotoxicity · 12 months
- Cumulative incidence
- 8.3% (95% CI: 7.1%-9.1%)
- Additional events through 2 years
- 5
Original publication
A Simple Clinical Risk Score to Improve Prediction of Anthracycline-Induced Cardiotoxicity. JACC CardioOncol. Published August 2026. doi:10.
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