There are two models in question, both based on standard health indicators. One is intended for assessing risk in the general population, while the other is specifically for people who have already experienced cardiovascular ailments.

The overall aim is to identify higher-risk individuals as early on as possible, in order to delay or, where possible, wholly prevent the onset of the disease.

While models for heart failure have been developed in the past, many of these either cannot be used in actual prevention or have limited utility due to overly complex variables which are not typically collected during a normal doctor's consultation. The new models, by contrast, are based on large pan-European datasets, making them likely to be recommended in the European Society of Cardiology guidelines due to be published later this year.

A major health risk

Estonia is in the high-risk category of European countries for heart failure. Many Western European countries, such as France, Spain, Norway and even the U.K., are classified as low-risk. However: "In Eastern Europe, most countries have a high or very high risk," Lõo noted.

According to the expert, heart failure is in any case a major public health issue both Europe-wide and in Estonia specifically. Medical professionals have forecast that an increasing number of people will be getting these types of diagnoses as the population continues to age, too. This will in turn affect the healthcare system and public health more broadly. "This is a disease that affects not only life expectancy but also quality of life to a great extent," the junior researcher noted.

People with heart failure typically experience shortness of breath and fatigue, with everyday activities often becoming difficult for them, and hospitalization often resorted to, in part due to the dearth of early warning systems. "Heart failure is often detected at a late stage, when the disease has already progressed quite far. This means that prevention and early intervention could have great potential, one that is currently underused," Lõo said. Risk factors for heart failure include pre-existing long-term high blood pressure, being a smoker, and other lifestyle-related factors such as having excessive body weight. The risk is also higher for people who have already been diagnosed with another cardiovascular disease. "Often, if a person has had a heart attack or a stroke, the risk of developing heart failure increases," the expert added.

According to Lõo, various estimates suggest that as much as 80–90 percent of heart disease incidence could be preventable.

Two novel models

Via international collaboration, Lõo and other researchers developed two new models designed to complement each other. The first, SCORE2-HF, is as noted intended for the general populace — that is, people who have not been diagnosed with any cardiovascular disease. This model allows the risk of developing heart failure to be assessed over a period of up to 30 years.

"This model is based on data that are routinely collected in healthcare and measured during regular doctor visits. These include blood pressure, body mass index, whether a person smokes, whether they have diabetes, and so on," Lõo explained.

At the same time, the researchers developed the SMART2-HF model, which is aimed at people who have already been diagnosed with cardiovascular disease.

"Since these individuals have a fairly high risk of developing heart failure, the model helps assess who is more likely to develop the condition within the next ten years. Together, these two models cover almost the entire risk spectrum: both healthy individuals and those with heart disease. They can serve as important decision-support tools for doctors," the junior researcher explained. Previous models for predicting cardiovascular disease risk have largely overlooked heart failure. For example, the SCORE2 model recommended by the European Society of Cardiology predicts heart attack and stroke, but not heart failure. The new SCORE2-HF model addresses this gap.

Being at high risk does not necessarily translate into actual full-blown heart failure, but at the same time both of the models can help doctors understand how high a person's risk may be and consider whether early intervention is needed to prevent the disease.

Estonian data played a very significant role in the development of both models. In developing the SCORE2-HF model, researchers used Estonia's unique BIG-HEART database, which includes health and social data on approximately 800,000 people in a country with a population of around 1.3 million.

"This means that we adapted the SCORE2-HF model to Estonia's risk level, so it is already suitable for use in Estonia. Without this step, we would actually underestimate the risk in Estonia, but now we have adjusted it to be appropriate for high-risk countries," Lõo noted.

Additionally, the researchers have tested the reliability of the model by validating the results using data from the Estonian Biobank. The SMART2-HF model was also tested using Biobank data. "In my opinion, this shows that Estonian data play a very important role in international collaboration," Lõo continued.

Lõo said she hopes that in the future the models could be available on family doctors' desktops, and they will likely also be included in European clinical guidelines. "Ultimately, it is up to the doctor to decide whether to use them or not, but guidelines do encourage their use."

"Predicting disease risk is in some ways like forecasting the weather: You can never say with 100 percent certainty whether it will rain; the same applies in healthcare. However, we can estimate the likelihood of disease, and this helps people prepare and make changes in their health behavior to prevent illness as effectively as possible," Lõo concluded.

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