Heart Failure Life Expectancy Calculator (MAGGIC Risk Score)

Predicts mortality risk from HF within 1 or 3 years, based on patient data, cardiac and comorbidity parameters.

Refer to the text below the tool for more information about the parameters involved, their weight in the final score and mortality interpretations.


Heart failure with preserved EF is a condition that is rising in incidence and is associated with significant mortality.

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Risk Calculator predicts mortality risk at 1 and 3 years in adult (≥18 years) patients with heart failure or reduced or preserved ejection fraction.


The MAGGIC risk calculator is based on a study led by an international group of researchers, on a cohort of 39,372 patients from 30 studies. The 13 parameters used as mortality risk factors have been found using a Poisson regression model.


Age
Ejection Fraction
Systolic Blood Pressure
Do you know the BMI value?
BMI
Creatinine
Gender
Current smoker
Diabetes
NYHA Class
Chronic Obstructive Pulmonary Disease (COPD)
Heart failure first diagnosed ≥18 months ago
Beta blocker
ACEi/ARB
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Steps on how to print your input & results:

1. Fill in the calculator/tool with your values and/or your answer choices and press Calculate.

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.


 

About MAGGIC Risk for HF

Heart failure with preserved EF is a condition that is rising in incidence and is associated with significant mortality. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Risk Score predicts mortality risk at 1 and 3 years in adult (≥18 years) patients with heart failure or reduced or preserved ejection fraction.

The score is considered by some limited, for its exclusion of biomarkers such as B-type natriuretic peptide, that were found to correlate with mortality. MAGGIC has not been yet externally validated for patients with reduced EF.

The MAGGIC risk calculator is based on a study led by an international group of researchers, on a cohort of 39,372 patients from 30 studies. The 13 parameters used as mortality risk factors have been found using a Poisson regression model. All risk factors were found highly significant, with P<0.002, with some overwhelmingly significant P<0.0001.

A subsequent validation study by Freed et al. found that in a cohort of 308 patients with heart failure and preserved ejection fraction, the higher MAGGIC risk scores were associated with more adverse events.

Ejection Fraction (EF) <20 20 - 24 25 - 29 30 - 34 35 - 39 ≥40
7 6 5 3 2 0
BMI <15 15 – 19 20 – 24 25 – 29 ≥30  
6 5 3 2 0
Creatinine in μmol/L < 90 90 -109 110 - 129 130 - 149 150 - 169 170 - 209 210 - 249 ≥250
0 1 2 3 4 5 6 8
Age Years < 55 55 – 59 60 – 64 65 – 69 70 – 74 75 – 79  
If EF <30 0 1 2 4 6 8 10
If EF 30-39 0 2 4 6 8 10 13
If EF ≥40 0 3 5 7 9 12 15
Systolic Blood Pressure SBP <110 110 - 119 120 - 129 130 - 139 140 - 149 ≥150  
If EF <30 5 4 3 2 1 0
If EF 30-39 3 2 1 1 0 0
If EF ≥40 2 1 1 0 0 0

Risk Factors

  • Male (+1);
  • Smoker (+1);
  • Diabetic (+3);
  • Chronic obstructive pulmonary disease (COPD) (+2);
  • Heart failure first diagnosed ≥18 months ago (+2);
  • Not on beta blocker (+3);
  • Not on ACE-I/ARB (+1).

The integer score ranges from 0 points (1.5% for 1-year and 3.9% for 3-year mortality risk) to 50 points (84.2% for 1-year and 98.5% for 3-year mortality risk)

The BMI variable has a linear trend up to 30 kg/m2, while above 30 kg/m2 the risk is constant, which follows a similar trajectory for ejection fraction (values above 40%) and creatinine (values above 350 μmol/L).

The interaction between EF and age in years indicates a 4% increase in mortality for each 10-year increase in age and a 5% increase in EF on top of the risks of EF and age considered independently.

The interaction between EF and SBP indicates an extra 1.2% increase in mortality for each simultaneous 10 mmHg increase in SBP.

The above two findings are suggestive of the fact that the protective effect of increased EF diminishes with aging and as patient SBP increases.

 

Heart Failure (HF)

Whilst HF is a major cause of death, prognosis prediction in individual patients can be highly variable. The American College of Cardiology (ACC) and the American Heart Association (AHA) first published guidelines for the evaluation and management of HF (identifying 4 stages – summarized below) in 1995, then updated in 2001.

Stage A Patient has no structural disorder of the heart but is at high risk of developing HF. E.g. systemic hypertension, coronary artery disease, diabetes mellitus, family history of cardiomyopathy etc.
Stage B Patient has a structural disorder of the heart but has never developed symptoms of HF. E.g. left ventricular hypertrophy or fibrosis, left ventricular dilatation, asymptomatic valvular heart disease or previous myocardial infarction
Stage C Patient has past or current HF symptoms associated with an underlying structural heart disease. E.g. left ventricular systolic dysfunction (dyspnea or fatigue).
Stage D Patient has end-stage HF and requires mechanical circulatory support, continuous inotropic infusions, cardiac transplantation, or hospice care. E.g. patients frequently hospitalized for HF, patients awaiting heart transplantation etc.

This classification system is intended to complement but not to replace the New York Heart Association (NYHA) functional classification.

 

References

Original reference

Pocock SJ, Ariti CA, McMurray JJ, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013; 34(19):1404-1413.

Validation

Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, Klein DA, Dixon D, Baldridge A, Rasmussen-Torvik LJ, Maganti K, Shah SJ. Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain. Circ Cardiovasc Imaging. 2016; 9(3):10.1161.

Other references

Hunt SA, Baker DW, Chin MH, et al. ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation. 2001; 104(24):2996-3007.

Martínez-Sellés M, Doughty RN, Poppe K, et al. Gender and survival in patients with heart failure: interactions with diabetes and aetiology. Results from the MAGGIC individual patient meta-analysis. Eur J Heart Fail. 2012; 14(5):473-479.

Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. Eur Heart J. 2012; 33(14):1750-1757.


Specialty: Cardiology

System: Cardiovascular

Year Of Study: 2013

Abbreviation: MAGGIC

Article By: Denise Nedea

Published On: July 1, 2020

Last Checked: July 1, 2020

Next Review: July 1, 2025