Although widely used risk scores provide insight into the prognosis of patients with heart failure (HF), they should be improved to take into account sex- and group-specific disease phenotypes and etiologies, according to an editorial published in the Canadian Journal of Cardiology reports.1

The Seattle Heart Failure Model (SHFM) and the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk scores are 2 validated tools used to establish a prognosis for patients at different stages of HF. The SHFM and MAGGIC scores were developed in a cohort predominantly consisting of men. However, female vs male sex was found to be associated with improved survival in patients with reduced ejection fraction (HFrEF). The risk scores may therefore not provide an adequate prognosis in women.

In a retrospective cohort study published in the same issue, the predictive values of the SHFM and MAGGIC scores were assessed separately in women and men with HFrEF who visited a hospital in Canada.2

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The analysis of a composite endpoint of mortality, implantation of a ventricular assist device, or transplantation indicated no gender-based differences for mortality. Although both scores were found to overestimate the 3-year mortality of patients, the MAGGIC, but not the SHFM, score overestimated this parameter in men. In addition, the MAGGIC provided a greater risk classification compared with the SHFM score in both sexes at the 1- and 3-year follow-ups.

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“Moving forward, as researchers and cardiologists, we should always endeavor to include patients

from underrepresented vulnerable populations in studies so we can gather information applicable to a variety of groups and sexes” noted the authors of the editorial.


1. Diamant MJ, Toma M. Should we be using sex-specific heart failure risk scores? Can J Cardiol. 2020;36(1):11-12.

2. Vishram-Nielsen JKK, Foroutan F, Ross HJ, Gustafsson F, Alba AC. Performance of prognostic risk scores in heart failure patients: do sex differences exist? Can J Cardiol. 2020;36(1):45-53.