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Published on: June 10, 2025
Risk stratification in women enrolled in the Acute Decompensated Heart Failure National Registry Emergency Module
Deborah B Diercks1, Gregg C Fonarow, J Douglas Kirk
1University of California, Davis Medical Center, Sacramento, CA, USA. dbdiercks@ucdavis.edu
Insights
The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) Classification and Regression Tree (CART) model effectively predicts heart failure risk in both men and women. This tool ensures accurate risk stratification regardless of gender, improving patient care.
Area of Science:
- Cardiology
- Clinical Research
- Health Outcomes
Background:
- Heart failure mortality risk may differ between genders, potentially due to comorbid conditions.
- Existing risk stratification algorithms may have limited performance in women with heart failure.
- Understanding gender-specific risk profiles is crucial for effective heart failure management.
Purpose of the Study:
- To evaluate the performance of a published risk stratification model in predicting outcomes for women with heart failure.
- To determine if the ADHERE Registry CART model effectively stratifies risk in female heart failure patients.
Main Methods:
- Utilized the Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) database.
- Compared characteristics, treatments, and outcomes between male and female patients.
- Applied the ADHERE Registry Classification and Regression Tree (CART) analysis for risk stratification.
Main Results:
- In-hospital mortality was similar between men and women (52.2% of 10,984 patients were women).
- Significant gender differences were observed in CART model variables: elevated blood urea nitrogen (BUN), low systolic blood pressure, and high serum creatinine.
- The CART model successfully stratified both genders into distinct risk groups with no significant gender-based mortality differences within these groups.
Conclusions:
- The ADHERE Registry CART tool demonstrates effectiveness in predicting risk for emergency department patients with heart failure.
- The model's predictive capability is consistent across genders, making it a valuable tool for all patients.
Objectives:
It has been reported that the mortality risk for heart failure differs between men and women. It has been postulated that this is due to differences in comorbid features. Variation in risk profiles by gender may limit the performance of stratification algorithms available for heart failure in women. This analysis examined the ability of a published risk stratification model to predict outcomes in women.
Methods:
The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) database was used. Characteristics, treatments, and outcomes for men and women were compared. The ADHERE registry classification and regression tree (CART) analysis was used for the risk stratification evaluation.
Results:
Of 10,984 ADHERE-EM patients, 5,736 (52.2%) were women. In-hospital mortality was similar between men and women (p = 0.727). Significant differences (p < 0.0002) were noted by gender in all three variables in the CART model (blood urea nitrogen [BUN] > or = 43 mg/dL, systolic blood pressure < 115 mm Hg, and serum creatinine > or = 2.75 mg/dL). However, the CART model effectively stratified both genders into distinct risk groups with no significant difference in mortality by gender within stratified groups.
Conclusions:
The ADHERE Registry CART tool is effective at predicting risk in ED patients, regardless of gender.
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