Pocock SJ, Ferreira JP, Gregson J, et al. - For patients with heart failure with reduced ejection fraction (HFrEF), prognosis can be assessed using the combination of N-terminal pro B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) with a small number of readily available clinical variables.

• Thirty-three candidate variables were chosen in advance in EMPEROR-Reduced.

• Stepwise selection was used to develop multivariable Cox regression models for: (i) the primary composite outcome of HF hospitalization or cardiovascular death, (ii) all-cause death, and (iii) cardiovascular mortality.

• Follow up was performed of a total of 3,730 patients for a median of 16 months.

• The dominant predictors of the primary outcome were NT-proBNP and hs-cTnT, and in addition, the following were key predictors: a shorter time since last HF hospitalization, longer time since HF diagnosis, lower systolic blood pressure, New York Heart Association (NYHA) Class III or IV, higher heart rate and peripheral edema (eight variables in total).

• Good discrimination was made using the primary outcome risk score, with an event rate > 9 times higher for patients in the top 10th of risk vs those in the bottom 10th.

• Patients across risk levels for the primary outcome benefit from receiving empagliflozin.

• The predictors of all-cause and cardiovascular mortality also included NT-proBNP and hs-cTnT, predominantly, followed by NYHA Class III or IV and ischaemic etiology (four variables in total).

• Good event discrimination was made for all-cause and cardiovascular mortality using the mortality risk model.

• External validation of these simple models was done in the BIOSTAT-CHF study, achieving similar c-statistics.