The 3A3B score: The simple risk score for heart failure with preserved ejection fraction - A report from the CHART-2 Study

Shintaro Kasahara, Yasuhiko Sakata, Kotaro Nochioka, Wan Ting Tay, Brian Lee Claggett, Ruri Abe, Takuya Oikawa, Masayuki Sato, Hajime Aoyanagi, Masanobu Miura, Takashi Shiroto, Jun Takahashi, Koichiro Sugimura, Tiew Hwa Katherine Teng, Satoshi Miyata, Hiroaki Shimokawa

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


Background: Few simple risk models, without echocardiography have been developed for patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) (HFpEF). Methods: To develop a risk score to predict all-cause death for HFpEF patients, we examined 1277 HF patients with LVEF ≥50% and BNP ≥100 pg/ml in the CHART-2 Study, a large-scale prospective cohort study for HF in Japan. We selected the optimal subset of covariates for the score with Cox proportional hazard models and random survival forests (RSF). Results: During the median 5.7-year follow-up, 576 deaths occurred. Cox models and RSF analyses consistently indicated age ≥75 years, albumin <3.7 g/dl, anemia, BMI <22 kg/m 2 , BNP ≥300 pg/ml (or NT-proBNP ≥1400 pg/ml), and BUN ≥25 mg/dl, as the important 6 prognostic variables. Incorporating these 6 variables, we developed a scoring system (3A3B score, with 2 points given to age ≥75 years and 1 point to the others based on the hazard ratios. The discrimination ability of the risk score was excellent (c-index 0.708). Regarding model goodness-of-fit, the overall gradient in 5-year risk was well captured by the score. The predictive accuracy of the 3A3B score was confirmed in the external validation cohorts from the TOPCAT trial (N = 835, c-index 0.652) and the ASIAN-HF registry (N = 170, c-index 0.741). Conclusions: We developed a simple risk score to predict long-term prognosis of HFpEF patients. The 3A3B score, comprising 6 commonly available parameters in daily practice, has potential utility in the risk stratification and management of HFpEF patients.

Original languageEnglish
Pages (from-to)42-49
Number of pages8
JournalInternational Journal of Cardiology
Publication statusPublished - 2019 Jun 1


  • Heart failure
  • HFpEF
  • Left ventricular ejection fraction
  • Prognosis
  • Risk score


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