{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:58:22Z","timestamp":1776351502016,"version":"3.51.2"},"reference-count":35,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2022JJ70042"],"award-info":[{"award-number":["2022JJ70042"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,20]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Objectives<\/jats:title>\n To identify risk factors and develop a predictive model for postdischarge all-cause mortality in patients with heart failure with preserved ejection fraction (HFpEF).<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Retrospective cohort study.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Tertiary care, Xiangtan Central Hospital, Hunan, China.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 9419 patients with HFpEF, diagnosed between May 2014 and January 2023 according to 2021 European Society of Cardiology criteria (N-terminal pro-B-type natriuretic peptide (NT-proBNP) \u2265125\u2009pg\/mL, left ventricular ejection fraction \u226550%, New York Heart Association (NYHA) class II-IV). Exclusions were age <18 years, pregnancy, malignancy with life expectancy <1 year, dialysis-dependent renal failure, non-cardiac life expectancy <1 year and in-hospital death during index admission. Patients were allocated to a training cohort (n=6935) and a temporal validation cohort (n=2484).<\/jats:p>\n <\/jats:sec>\n \n Primary outcome measures<\/jats:title>\n All-cause mortality within 3 years of hospital discharge.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 10 independent predictors were identified: NT-proBNP, albumin, age, NYHA class III-IV, C reactive protein, right atrial end-systolic diameter, haemoglobin, chronic obstructive pulmonary disease, hyponatraemia and prior percutaneous coronary intervention. The prediction model demonstrated good discrimination, an area under the receiver operating characteristic curve of 0.756 (95% CI 0.743 to 0.769) in the training cohort and 0.764 in the validation cohort. Based on calculated risk scores, patients were classified into low-risk (\u2264200.36), medium-risk (200.37\u2013232.24) and high-risk (\u2265232.25) groups, corresponding to 3-year mortality rates of 12.6%, 40.8% and 68.0%, respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A simple clinical model using routinely available parameters enables effective 3-year mortality risk stratification in HFpEF patients after discharge. External validation is needed to confirm its generalisability.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT06487468<\/jats:ext-link>.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094909","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T06:00:27Z","timestamp":1757570427000},"page":"e094909","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Development and validation of a prediction model for all-cause death in heart failure patients with preserved ejection fraction: a single-centre cohort study in China"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"nct06487468","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06487468","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct06487468","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Yunlong","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"},{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2085-2410","authenticated-orcid":false,"given":"Wenjiao","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5532-1632","authenticated-orcid":false,"given":"Zhican","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6680-6312","authenticated-orcid":false,"given":"Dan","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2796-8772","authenticated-orcid":false,"given":"Liang","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1867-8441","authenticated-orcid":false,"given":"Weifeng","family":"He","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6190-2119","authenticated-orcid":false,"given":"Kang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haobo","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6593-9951","authenticated-orcid":false,"given":"Mingxing","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4485-6164","authenticated-orcid":false,"given":"JianPing","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5388-7766","authenticated-orcid":false,"given":"Shenghua","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"2025091023001288000_15.9.e094909.1","first-page":"5","article-title":"2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (ESC) with the special contribution of the heart failure association (HFA) of the ESC","volume":"26","author":"McDonagh","year":"2023","journal-title":"Eur J Heart Fail"},{"key":"2025091023001288000_15.9.e094909.2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwaa147"},{"key":"2025091023001288000_15.9.e094909.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.01.049"},{"key":"2025091023001288000_15.9.e094909.4","first-page":"235","article-title":"Chinese guidelines for the diagnosis and treatment of heart failure 2024","volume":"52","year":"2024","journal-title":"Zhonghua Xin Xue Guan Bing Za Zhi"},{"key":"2025091023001288000_15.9.e094909.5","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.121.008406","article-title":"Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis","volume":"14","author":"Wang","year":"2021","journal-title":"Circ Heart Fail"},{"key":"2025091023001288000_15.9.e094909.6","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.cardfail.2017.09.014","article-title":"Contemporary Epidemiology, Management, and Outcomes of Patients Hospitalized for Heart Failure in China: Results From the China Heart Failure (China-HF) Registry","volume":"23","author":"Zhang","year":"2017","journal-title":"J Card Fail"},{"key":"2025091023001288000_15.9.e094909.7","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCHEARTFAILURE.120.007901","article-title":"Global Differences in Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial","volume":"14","author":"Tromp","year":"2021","journal-title":"Circ Heart Fail"},{"key":"2025091023001288000_15.9.e094909.8","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1002\/ejhf.2654","article-title":"Clinical characteristics and 1-year outcomes in hospitalized patients with heart failure with preserved ejection fraction: results from the China Cardiovascular Association Database-Heart Failure Center Registry","volume":"24","author":"Cai","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2025091023001288000_15.9.e094909.9","doi-asserted-by":"crossref","first-page":"e611","DOI":"10.1016\/S2214-109X(23)00605-8","article-title":"Mortality in patients admitted to hospital with heart failure in China: a nationwide Cardiovascular Association Database-Heart Failure Centre Registry cohort study","volume":"12","author":"Wang","year":"2024","journal-title":"Lancet Glob Health"},{"key":"2025091023001288000_15.9.e094909.10","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1111\/echo.14764","article-title":"Cardiac mechanics in heart failure with preserved ejection fraction","volume":"37","author":"Seetharam","year":"2020","journal-title":"Echocardiography"},{"key":"2025091023001288000_15.9.e094909.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.02.005"},{"key":"2025091023001288000_15.9.e094909.12","doi-asserted-by":"crossref","first-page":"1869","DOI":"10.1002\/ejhf.2607","article-title":"Biomarker-driven prognostic models in chronic heart failure with preserved ejection fraction: the EMPEROR-Preserved trial","volume":"24","author":"Pocock","year":"2022","journal-title":"Eur J Heart Fail"},{"key":"2025091023001288000_15.9.e094909.13","doi-asserted-by":"crossref","first-page":"4455","DOI":"10.1093\/eurheartj\/ehab579","article-title":"Novel biomarker-driven prognostic models to predict morbidity and mortality in chronic heart failure: the EMPEROR-Reduced trial","volume":"42","author":"Pocock","year":"2021","journal-title":"Eur Heart J"},{"key":"2025091023001288000_15.9.e094909.14","doi-asserted-by":"publisher","DOI":"10.1093\/cvr\/cvaa217"},{"key":"2025091023001288000_15.9.e094909.15","first-page":"2947","article-title":"The clinical significance of changes in cTnT, CRP and NT-proBNP levels in patients with heart failure","volume":"13","author":"Wang","year":"2021","journal-title":"Am J Transl Res"},{"key":"2025091023001288000_15.9.e094909.16","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ancard.2020.07.012","article-title":"Serum albumin and cardiovascular disease: State-of-the-art review","volume":"69","author":"Arques","year":"2020","journal-title":"Ann Cardiol Angeiol (Paris)"},{"key":"2025091023001288000_15.9.e094909.17","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1002\/mas.21743","article-title":"Novel insights about albumin in cardiovascular diseases: Focus on heart failure","volume":"42","author":"Zoanni","year":"2023","journal-title":"Mass Spectrom Rev"},{"key":"2025091023001288000_15.9.e094909.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijbiomac.2021.06.140"},{"key":"2025091023001288000_15.9.e094909.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2013.04.018"},{"key":"2025091023001288000_15.9.e094909.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.11.031"},{"key":"2025091023001288000_15.9.e094909.21","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.119.014716","article-title":"Serum Albumin Is a Marker of Myocardial Fibrosis, Adverse Pulsatile Aortic Hemodynamics, and Prognosis in Heart Failure With Preserved Ejection Fraction","volume":"9","author":"Prenner","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025091023001288000_15.9.e094909.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.07.046"},{"key":"2025091023001288000_15.9.e094909.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2018.06.008"},{"key":"2025091023001288000_15.9.e094909.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2016.05.011"},{"key":"2025091023001288000_15.9.e094909.25","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-79729-6","article-title":"Left ventricular fibrosis and hypertrophy are associated with mortality in heart failure with preserved ejection fraction","volume":"11","author":"Garg","year":"2021","journal-title":"Sci Rep"},{"key":"2025091023001288000_15.9.e094909.26","doi-asserted-by":"crossref","DOI":"10.1002\/pul2.12216","article-title":"Novel left ventricular mechanical index in pulmonary arterial hypertension","volume":"13","author":"Ichimura","year":"2023","journal-title":"Pulm Circ"},{"key":"2025091023001288000_15.9.e094909.27","doi-asserted-by":"crossref","DOI":"10.14814\/phy2.14222","article-title":"Hypovolemia and reduced hemoglobin mass in patients with heart failure and preserved ejection fraction","volume":"7","author":"Montero","year":"2019","journal-title":"Physiol Rep"},{"key":"2025091023001288000_15.9.e094909.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.03.017"},{"key":"2025091023001288000_15.9.e094909.29","doi-asserted-by":"crossref","first-page":"2458","DOI":"10.1002\/ehf2.13366","article-title":"Left atrial volume and left ventricular mass indices in heart failure with preserved and reduced ejection fraction","volume":"8","author":"Gehlken","year":"2021","journal-title":"ESC Heart Fail"},{"key":"2025091023001288000_15.9.e094909.30","doi-asserted-by":"crossref","DOI":"10.1161\/HCQ.0000000000000121","article-title":"2023 AHA\/ACC Clinical Performance and Quality Measures for Coronary Artery Revascularization: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Performance Measures","volume":"16","author":"Dehmer","year":"2023","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2025091023001288000_15.9.e094909.31","first-page":"3720","article-title":"2023 ESC Guidelines for the management of acute coronary syndromes","volume":"44","author":"Byrne","year":"2023","journal-title":"G Ital Cardiol (Rome)"},{"key":"2025091023001288000_15.9.e094909.32","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/14779072.2022.2058931","article-title":"Management and outcomes of acute myocardial infarction in patients with preexisting heart failure: an analysis of 2 million patients from the national inpatient sample","volume":"20","author":"Abramov","year":"2022","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"2025091023001288000_15.9.e094909.33","doi-asserted-by":"crossref","first-page":"779282","DOI":"10.3389\/fcvm.2021.779282","article-title":"Prognostic Value of Multiple Circulating Biomarkers for 2-Year Death in Acute Heart Failure With Preserved Ejection Fraction","volume":"8","author":"Gao","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"2025091023001288000_15.9.e094909.34","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1001\/jamacardio.2024.0284","article-title":"Prognostic Models for Mortality and Morbidity in Heart Failure With Preserved Ejection Fraction","volume":"9","author":"McDowell","year":"2024","journal-title":"JAMA Cardiol"},{"key":"2025091023001288000_15.9.e094909.35","doi-asserted-by":"crossref","first-page":"6785","DOI":"10.2147\/JIR.S366903","article-title":"A Novel Nomogram Integrated with Systemic Inflammation Markers and Traditional Prognostic Factors for Adverse Events\u2019 Prediction in Patients with Chronic Heart Failure in the Southwest of China","volume":"15","author":"Liu","year":"2022","journal-title":"J Inflamm Res"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2024-094909","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T06:00:32Z","timestamp":1757570432000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2024-094909"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,10]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bmjopen-2024-094909"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2024-094909","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}