EAARN score, a predictive score for mortality in patients receiving cardiac resynchronization therapy based on
Malek Khatib1, José M Tolosana, Emilce Trucco
1Thorax Institute, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
Insights
This study identified key predictors of mortality in cardiac resynchronization therapy (CRT) patients, developing the EAARN score to assess prognosis and improve patient outcomes in heart failure management.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Technology
Background:
- Cardiac Resynchronization Therapy (CRT) is established for advanced heart failure with low ejection fraction (LVEF) and wide QRS.
- Despite CRT, some patients experience high mortality rates, necessitating better risk stratification.
Purpose of the Study:
- To identify predictors of mortality in patients undergoing CRT.
- To develop a novel risk score for predicting mortality in this patient cohort.
Main Methods:
- Prospective analysis of 608 CRT patients from 2000-2011.
- Multivariate analysis of clinical and echocardiography variables to determine mortality predictors.
- Development of the EAARN score based on identified predictors.
Main Results:
- Key mortality predictors identified: NYHA class IV, GFR <60 mL/min/1.73 m², atrial fibrillation (AF), age ≥70 years, and LVEF <22%.
- The EAARN score (EF, Age, AF, Renal dysfunction, NYHA class IV) effectively summarizes these predictors.
- Each additional predictor in the EAARN score significantly increased mortality risk.
Conclusions:
- Identified mortality predictors have a significant additive effect on patient outcomes.
- The EAARN score offers a valuable tool for stratifying prognosis in CRT patients.
Aims:
The beneficial effects of CRT in patients with advanced heart failure, wide QRS, and low LVEF have been clearly established. Nevertheless, mortality remains high in some patients. The aims of our study were to identify the predictors of mortality in patients treated with CRT and to design a risk score for mortality.
Methods And Results:
A cohort of 608 consecutive patients treated with CRT from 2000 to 2011 in our centre was prospectively analysed. Baseline clinical and echocardiography variables were analysed and mortality data were collected. During a mean follow-up of 36.2 ± 29.2 months, 174 patients died: 123/174 (71%) due to cardiovascular causes, 25/174 (14%) non-cardiac causes, and 26/174 (15%) unknown aetiology. In a multivariate analysis the predictors of mortality were NYHA class IV [hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.7-3.7, P < 0.001], glomerular filtration rate (GFR) <60 mL/min/1.73 m2 (HR 1.61, 95% CI 1.14-2.30, P = 0.008), AF (HR 1.67, 95% CI 1.19-2.3, P = 0.01), age ≥70 years (HR 1.44, (95% CI 1.04-2.00, P = 0.02), and LVEF <22% (HR 1.83, 95% CI 1.33-2.52, P ≤ 0.001). The EAARN score (EF, Age, AF, Renal dysfunction, NYHA class IV) summarizes the predictors. Each additional predictor increased the mortality: one predictor, HR 3.28 (95% CI 1.37-7.8, P = 0.008); two, HR 5.23 (95% CI 2.24-12.10, P < 0.001); three, HR 9.63 (95% CI 4.1-22.60, P < 0.001); and four or more, HR 14.38 (95% CI 5.8-35.65, P < 0.001).
Conclusion:
The predictors of mortality have a significant add-on predictive effect on mortality. The EAARN score could be useful to stratify the prognosis of CRT patients.
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