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    MAGGIC Risk Calculator for Heart Failure

    Estimates 1- and 3- year mortality in heart failure.
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    INSTRUCTIONS

    Use in adult patients (≥18 years). Use with caution in patients with reduced ejection fraction (not yet externally validated in this population).

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients with heart failure and preserved EF.

    • The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Risk Calculator assigns an integer score based on heart failure risk factors to predict mortality at 1 and 3 years.
    • Can be used in heart failure patients with reduced or preserved ejection fraction (EF).
    • Not yet externally validated for patients with reduced EF.
    • Excludes biomarkers known to correlate with mortality, such as B-type natriuretic peptide.

    Heart failure with preserved EF has significant mortality and is rising in incidence. Predictive models to stratify risk for these patients are necessary.

    years
    %
    mm Hg
    kg/m²
    mg/dL

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    Consider individualized choice of pharmacotherapy (e.g. beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers) for treatment of heart failure based on score.

    Formula

    Addition of selected points.

    Facts & Figures

    Risk Factor Points

    Male

    Smoker

    Diabetic

    COPD

    First diagnosis of HF within 18 months

    Not on beta blocker

    Not on ACE-I/ARB

    +1

    +1

    +3

    +2

    +2

    +3

    +1

    Ejection fraction (EF)

    <20

    20-24

    25-29

    30-34

    35-39

    ≥40

    +7

    +6

    +5

    +3

    +2

    +0

    NYHA class

    1

    2

    3

    4

    +0

    +2

    +6

    +8 

     Creatinine

     <90

    90-109

    110-129

    130-149

    150-169

    170-209

    210-249

    ≥250

    +0

    +1

    +2

    +3

    +4

    +5

    +6

    +8 

    BMI 

    <15

    15-19

    20-24

     25-29

    ≥30

    +6

    +5

    +3

    +2

    +0 

    Extra for systolic BP (mm Hg) if EF <30

     

    <110

    110-119

    120-129

    130-139

    140-149

    ≥150

    +5

    +4

    +3

    +2

    +1

    +0 

     Extra for systolic BP (mm Hg) if EF 30-39

    <110

    110-119

    120-129

    130-139

    140-149

    ≥150

    +3

    +2

    +1

    +1

    +0

    +0

      Extra for systolic BP (mm Hg) if EF ≥40

     <110

    110-119

    120-129

    130-139

    140-149

    ≥150

    +2

    +1

    +1

    +0

    +0

    +0 

    Extra for age (years) if EF <30

    <55

    56-59

    60-64

    65-69

    70-74

    75-79

    ≥80

    +0

    +1

    +2

    +4

    +6

    +8

    +10

    Extra for age (years) if EF 30-39

    <55

    56-59

    60-64

    65-69

    70-74

    75-79

    ≥80

    +0

    +2

    +4

    +6

    +8

    +10

    +13 

    Extra for age (years) if EF ≥40

     <55

    56-59

    60-64

    65-69

    70-74

    75-79

    ≥80

    +0

    +3

    +5

    +7

    +9

    +12

    +15 

    Evidence Appraisal

    The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Risk Calculator was developed by an international group of researchers let by Pocock et al based on a database of 39,372 patients from 30 cohort studies (of which 6 were randomized clinical trials, accounting for approximately 24,000 patients).

    A Poisson regression model was built to identify 13 risk factors contributing to mortality in patients with heart failure. Comparisons of observed and expected 3-year mortality rates across all 30 studies showed acceptable goodness-of-fit. Two separate models were used for preserved versus reduced ejection fraction (EF).

    A subsequent study by Freed et al (2016) showed that for 308 patients with heart failure with preserved EF, a higher MAGGIC risk score was associated with more adverse events.

    The data have not yet been externally validated for reduced EF.

    Literature

    Dr. Stuart Pocock

    About the Creator

    Stuart Pocock, PhD, is a professor of medical statistics at the London School of Hygiene and Tropical Medicine. Dr. Pocock is a director of multiple research groups investigating epidemiology and pharmacoepidemiology. He has published many papers on major trials he has conducted, especially in cardiovascular disease.

    To view Dr. Stuart Pocock's publications, visit PubMed