Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides

Mitsuaki Sawano, Yasuyuki Shiraishi, Shun Kohsaka, Toshiyuki Nagai, Ayumi Goda, Atsushi Mizuno, Yasumori Sujino, Yuji Nagatomo, Takashi Kohno, Toshihisa Anzai, Keiichi Fukuda, Tsutomu Yoshikawa

Research output: Contribution to journalArticlepeer-review

59 Citations (Scopus)


Aims Predictive models for heart failure patients are widely used in the clinical practice to stratify patients’ mortality and enable clinicians to tailor and intensify their approach. However, such models have not been validated internationally. In addition, biomarkers are now frequently measured to obtain prognostic information, and the implications of this practice are not known. In this study, we aimed to validate the model performance of the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) score in a Japanese acute heart failure registry and further explore the incremental prognostic value of discharge B-type natriuretic peptide (BNP) level. Methods and Results In this study, we evaluated the registered data of 2215 consecutive acute HF patients (with 694 119 person-years follow-up) from a prospective multicentre registry (the West Tokyo Heart Failure) conducted in Japan from April 2006 to August 2016. The mean age was 73.0 ± 13.0, and 61.2% were male. The MAGGIC score demonstrated modest discrimination (c-index = 0.71, 95% confidence interval 0.67–0.74) and good calibration (R2 value = 0.97); there was constant overestimation for 1 year mortality. However, when the BNP level was added to the original MAGGIC variables, the model demonstrated good discrimination (c-index = 0.74, 95% confidence interval 0.70–0.78) with adequate calibration (R2 value = 0.91). The modified MAGGIC BNP score was externally validated in a separate Japanese registry (NaDEF) and demonstrated moderate discrimination (c-index = 0.69, 95% confidence interval 0.65–0.73) and calibration (R2 value = 0.85). Conclusion The original MAGGIC score performed modestly in Japanese patients, but the addition of discharge BNP level enhanced model performance. The addition of objective biomarkers may result in effective modification of preexisting internationally recognized risk models and aid in multinational comparisons of heart failure patients’ outcomes.

Original languageEnglish
Pages (from-to)610-619
Number of pages10
JournalESC Heart Failure
Issue number4
Publication statusPublished - 2018 Aug


  • East Asia
  • Heart failure
  • Prediction
  • Validation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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