What is MAGGIC risk score?

What is MAGGIC risk score?

Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was developed by Pocock SJ et al for predicting mortality in heart failure [1]. It was based on 39,372 patients with median follow up of 2.5 years, from 30 studies and comprises of 13 clinical parameters. The parameters were age, lower ejection fraction, NYHA (New York Heart Association) class, serum creatinine, diabetes, not prescribed beta-blocker, lower systolic blood pressure, lower body mass, time since diagnosis, current smoker, chronic obstructive pulmonary disease, male gender, and not prescribed angiotensin converting enzyme inhibitor or angiotensin-receptor blockers, in the order of predictive strength.

In those with preserved ejection fraction, age was more predictive and systolic blood pressure less predictive of mortality than in reduced ejection fraction. After conversion to an integer risk score, there was a very marked gradient in risk, with 3 year mortality rate 10% in the bottom quintile and 70% in the top decile of risk. The integer risk score ranged from 0-52 points with a mean of 23 points. 95% of patients had scores in the range of 8 to 36 points.

The association of body mass index with mortality had an upper cut-off of 30 kg/m², above which no further trend was noted.

Eugene Braunwald, in an accompanying editorial pointed out several limitations of the score [2]. One of the negative points discussed in the editorial was that the authors thought that an external validation of the score was unnecessary. An external validation was published the next year using 51,043 patients from the Swedish heart failure registry [3]. The authors concluded that MAGGIC project heart failure risk score showed an excellent ability to categorize patients in separate risk strata, though there were some differences in the prediction.

Another limitation pointed out in the editorial was the non-inclusion of natriuretic peptides. A small external validation study of 407 patients having heart failure with preserved ejection fraction, enrolled in a prospective registry checked this as well [4]. They noted that brain natriuretic peptide was additive to the MAGGIC risk score for predicting outcomes. The conclusion was that MAGGIC risk score is a simple, yet powerful method of risk stratification for both morbidity and mortality in heart failure with preserved ejection fraction.

References

1. Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Køber L, Squire IB, Swedberg K, Dobson J, Poppe KK, Whalley GA, Doughty RN; Meta-Analysis Global Group in Chronic Heart Failure. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013 May;34(19):1404-13.
2. Braunwald E. Chronic heart failure: a look through the rear view mirror. Eur Heart J. 2013 May;34(19):1391-2. doi: 10.1093/eurheartj/ehs363. Epub 2012 Oct 26. PMID: 23103661.
3. Sartipy U, Dahlström U, Edner M, Lund LH. Predicting survival in heart failure: validation of the MAGGIC heart failure risk score in 51,043 patients from the Swedish heart failure registry. Eur J Heart Fail. 2014 Feb;16(2):173-9. doi: 10.1111/ejhf.32. Epub 2013 Dec 14. PMID: 24464911.
4. Rich JD, Burns J, Freed BH, Maurer MS, Burkhoff D, Shah SJ. 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. J Am Heart Assoc. 2018 Oct 16;7(20):e009594. doi: 10.1161/JAHA.118.009594. PMID: 30371285; PMCID: PMC6474968.