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May 25, 2005

Risk Stratification for In-Hospital Mortality in Acutely Decompensated Heart Failure

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(20):2467-2468. doi:10.1001/jama.293.20.2467-c

To the Editor: Dr Fonarow and colleagues1 estimate a risk model for in-hospital mortality in acutely decompensated heart failure using a large data set (>33 000 patients) and validate it on an equally large independent data set. However, their conclusion that a classification and regression tree (CART) model performs better than a linear logistic model in predicting the risk of death in patients with acutely decompensated heart failure is surprising. In the independent data set, the CART model yielded an area under the receiver operating characteristic curve (AUROC) of 0.668 compared with 0.757 for the logistic model. Although apparently modest, this represents a large difference in performance. A useless model would on average have an AUROC of 0.5. Subtracting 0.5 from the AUROC and considering a scale from 0 to 0.5 (the upper limit), the relative improvement offered by the logistic model is (0.257-0.168)/0.168 or 53%, which is considerable.