Heart failure & cardiomyopathies
Development and Validation of a Risk Score Predicting Death Without Transplant in Adult Heart Transplant Candidates
Errata to this article were published (JAMA, 9 Sep 2024 ↗ · 11 Feb 2025 ↗)
Authors' conclusion
In this registry-based study of US heart transplant candidates, a continuous multivariable allocation score outperformed the 6-status system in rank ordering heart transplant candidates by medical urgency and may be useful for the medical urgency component of heart allocation.
Study context
- Population
- Adult heart transplant candidates (aged ≥18 years) listed in the US heart allocation system, January 1, 2019–December 31, 2022796 (4.7%) died without transplant
- Participants
- 16,905 candidates
- Comparison
- US candidate risk score (US-CRS) vs French Candidate Risk Score (French-CRS) vs 6-status model
- Outcome
- Death without transplant within 6 weeks (time-dependent AUC) in the test dataset
- Follow-up
- 6 weeks
Methodological detailsregistry-based observational study, split by center into training (70%) and test (30%) datasets
- Registry-based observational study
- Split by center into training (70%) and test (30%) datasets
Performance
As reported in the abstract
AUC for death within 6 weeks of listing (test dataset)
| Test or model | AUC |
|---|---|
| US-CRS | 0.79 (95% CI, 0.75-0.83) |
| French-CRS | 0.72 (95% CI, 0.67-0.76) |
| 6-status model | 0.68 (95% CI, 0.62-0.73) |
AUC
US-CRS0.79 (95% CI, 0.75-0.83)
French-CRS0.72 (95% CI, 0.67-0.76)
6-status model0.68 (95% CI, 0.62-0.73)
Further findings
| Outcome | US-CRS | French-CRS | 6-status model |
|---|---|---|---|
| Overall c-index (test dataset) | |||
| C-index | 0.76 (95% CI, 0.73-0.80) | 0.69 (95% CI, 0.65-0.73) | 0.67 (95% CI, 0.63-0.71) |
Sensitivity analysis: Intra-aortic balloon pumps (IABP) and percutaneous ventricular assist devices (VAD) classified as short-term mechanical circulatory support (MCS)
- Reduced the effect size
- 54%
Original publication
Development and Validation of a Risk Score Predicting Death Without Transplant in Adult Heart Transplant Candidates. JAMA. Published 13 February 2024. doi:10.
Summarised from the published abstract; every number is checked against it