Performance of existing risk scores around heart transplantation: validation study in a 4‐year cohort

Summary Several risk scores exist to help identify best candidate recipients for heart transplantation ( HT x). This study describes the performance of five heart failure risk scores and two post‐ HT x mortality risk scores in a French single‐centre cohort. All patients listed for HT x through a 4‐year period were included. Waiting‐list risk scores [Heart Failure Survival Score ( HFSS ), Seattle Heart Failure Model ( SHFM ), Meta‐Analysis Global Group in Chronic Heart Failure ( MAGGIC ), Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure ( OPTIMIZE ‐ HF ) and Get With The Guidelines‐Heart Failure ( GWTG ‐ HF )] and post‐ HT x scores Index for Mortality Prediction After Cardiac Transplantation ( IMPACT and CARRS ) were computed. Main outcomes were 1‐year mortality on waiting list and after HT x. Performance was assessed using receiver operator characteristic ( ROC ), calibration and goodness‐of‐fit analyses. The cohort included 414 patients. Waiting‐list mortality was 14.0%, and post‐ HT x mortality was 16.3% at 1‐year follow‐up. Heart failure risk scores had adequate discrimination regarding waiting‐list mortality ( ROC AUC for HFSS  = 0.68, SHFM  = 0.74, OPTIMIZE ‐ HF  = 0.72, MAGGIC  = 0.70 and GWTG  = 0.77; all P ‐values <0.05). On the contrary, post‐ HT x risk scores did not discriminate post‐ HT x mortality ( AUC for IMPACT  = 0.58, and CARRS  = 0.48, both P ‐values >0.50). Subgroup analysis on patients undergoing HT x after ventricular assistance device ( VAD ) implantation (i.e. bridge‐to‐transplantation) ( n  = 36) showed an IMPACT AUC  = 0.72 ( P  < 0.001). In this single‐centre cohort, existing heart failure risk scores were adequate to predict waiting‐list mortality. Post‐ HT x mortality risk scores were not, except in the VAD subgroup.