Meta‐Analysis Global Group in Chronic (MAGGIC) Heart Failure Risk Score: Validation of a Simple Tool for the Prediction of Morbidity and Mortality in Heart Failure With Preserved Ejection Fraction

BACKGROUND: The Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) mortality risk score, derived from a large sample of patients with heart failure (HF) across the spectrum of ejection fraction (EF), has not yet been externally validated in a well‐characterized HF with preserved EF cohort with adjudicated morbidity outcomes. METHODS AND RESULTS: We evaluated the MAGGIC risk score (composed of 13 clinical variables) in 407 patients with HF with preserved EF enrolled in a prospective registry and used Cox regression to evaluate its association with morbidity/mortality. We used receiver‐operating characteristic analysis to compare the predictive ability of the MAGGIC risk score with the more complex Seattle Heart Failure Model, and we determined the value of adding B‐type natriuretic peptide to the MAGGIC risk score for risk prediction. During a mean follow‐up time of 3.6±1.8 years, 28% died, 32% were hospitalized for HF, and 55% had a cardiovascular hospitalization and/or death. The MAGGIC score, a mean±SD of 18±7, was significantly associated with mortality (P<0.0001), HF hospitalizations (P<0.0001), and the combined end point of cardiovascular‐related hospitalizations or death (hazard ratio, 1.8 [95% confidence interval, 1.6–2.1], per 1‐SD increase in the MAGGIC score; P<0.0001). Receiver‐operating characteristic analyses showed that MAGGIC and Seattle Heart Failure Model performed similarly in predicting HF with preserved EF outcomes, but the MAGGIC score demonstrated better calibration for hospitalization outcomes. Further analyses showed that B‐type natriuretic peptide was additive to the MAGGIC risk score for predicting outcomes (P<0.01 by likelihood ratio test). CONCLUSIONS: The MAGGIC risk score is a simple, yet powerful method of risk stratification for both morbidity and mortality in HF with preserved EF. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01030991.