The prognostic significance of the Rajan's heart failure risk score for mid-range ejection fraction in patients hospitalized for heart failure

INTRODUCTION: Heart failure with mid-range ejection fraction (HFmrEF) represents a distinct clinical entity with unique prognostic challenges, lacking widely adopted risk scoring tools for predicting mortality and rehospitalization. This study investigates the utility of Rajan's heart failure (R-HF) risk score as a simple and effective stratification tool in this patient population. MATERIAL AND METHODS In this retrospective cohort study, 175 HFmrEF patients were stratified by R-HF risk score into four groups: high risk, moderate risk, low risk, and minimal risk. The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was calculated for comparison. Receiver operating characteristic (ROC) curve and logistic regression analyses assessed the scores' predictive performance for a composite endpoint of HF-related rehospitalization and all-cause mortality. RESULTS The R-HF risk score showed an area under the ROC curve (AUC) of 0.822, suggesting strong predictive accuracy (p < 0.001). An optimal cut-off value of 10.30 achieved a sensitivity of 83.1% and a specificity of 75.0% for predicting HF-related rehospitalization and all-cause mortality. In comparison, the MAGGIC score yielded a lower AUC of 0.633 (p = 0.004). CONCLUSIONS The R-HF risk score effectively stratifies HFmrEF patients by risk, outperforming the frequently used MAGGIC score in this study's context. Its simplicity and prognostic reliability make it a valuable tool for managing HFmrEF patients, particularly in reducing HF-related rehospitalization and all-cause mortality (Table 4, Fig. 1, Ref. 18 ).