Document Detail

Development and validation of a risk score for predicting death in Chagas' heart disease.
MedLine Citation:
PMID:  16928995     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chagas' disease is an important health problem in Latin America, and cardiac involvement is associated with substantial morbidity and mortality. We developed a model to predict the risk of death in patients with Chagas' heart disease. METHODS: We retrospectively evaluated 424 outpatients from a regional Brazilian cohort. The association of potential risk factors with death was tested by Cox proportional-hazards analysis, and a risk score was created. The model was validated in 153 patients from a separate community hospital. RESULTS: During a mean follow-up of 7.9 years, 130 patients in the development cohort died. Six independent prognostic factors were identified, and each was assigned a number of points proportional to its regression coefficient: New York Heart Association class III or IV (5 points), evidence of cardiomegaly on radiography (5 points), left ventricular systolic dysfunction on echocardiography (3 points), nonsustained ventricular tachycardia on 24-hour Holter monitoring (3 points), low QRS voltage on electrocardiography (2 points), and male sex (2 points). We calculated risk scores for each patient and defined three risk groups: low risk (0 to 6 points), intermediate risk (7 to 11 points), and high risk (12 to 20 points). In the development cohort, the 10-year mortality rates for these three groups were 10 percent, 44 percent, and 84 percent, respectively. In the validation cohort, the corresponding mortality rates were 9 percent, 37 percent, and 85 percent. The C statistic for the point system was 0.84 in the development cohort and 0.81 in the validation cohort. CONCLUSIONS: A simple risk score was developed to predict death in Chagas' heart disease and was validated in an independent cohort.
Anis Rassi; Anis Rassi; William C Little; Sérgio S Xavier; Sérgio G Rassi; Alexandre G Rassi; Gustavo G Rassi; Alejandro Hasslocher-Moreno; Andrea S Sousa; Maurício I Scanavacca
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Publication Detail:
Type:  Journal Article; Validation Studies    
Journal Detail:
Title:  The New England journal of medicine     Volume:  355     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-24     Completed Date:  2006-08-31     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  799-808     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2006 Massachusetts Medical Society.
Division of Cardiology, Anis Rassi Hospital, Goiânia, Brazil.
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MeSH Terms
Analysis of Variance
Arrhythmias, Cardiac / etiology
Brazil / epidemiology
Bundle-Branch Block / etiology
Chagas Cardiomyopathy / mortality*
Chagas Disease / complications,  mortality
Cohort Studies
Follow-Up Studies
Middle Aged
Proportional Hazards Models
Retrospective Studies
Risk Assessment*
Risk Factors
Survival Analysis
Trypanosoma cruzi
Comment In:
N Engl J Med. 2006 Aug 24;355(8):760-1   [PMID:  16928993 ]
N Engl J Med. 2006 Dec 7;355(23):2489; author reply 2490-1   [PMID:  17162762 ]
N Engl J Med. 2006 Dec 7;355(23):2489; author reply 2490-1   [PMID:  17152683 ]
N Engl J Med. 2006 Dec 7;355(23):2488-9; author reply 2490-1   [PMID:  17151373 ]

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