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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure

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GRACE score predicts heart failure admission following acute coronary syndrome

David A McAllister1, Nynke Halbesma2, Kathryn Carruthers3

  • 1Centre for Population Health Sciences, University of Edinburgh, UK david.mcallister@ed.ac.uk.

European Heart Journal. Acute Cardiovascular Care
|July 3, 2014
PubMed

Insights

The Global Registry of Acute Coronary Events (GRACE) score effectively predicts heart failure admissions in patients with acute coronary syndrome (ACS). This score can identify high-risk individuals for targeted monitoring and treatment to prevent congestive heart failure (CHF).

Area of Science:

  • Cardiology
  • Clinical Risk Prediction
  • Public Health

Background:

  • Congestive heart failure (CHF) is a significant complication of acute coronary syndrome (ACS).
  • Existing risk scores for ACS have not reliably predicted the subsequent risk of developing CHF.
  • There is a need for validated tools to identify ACS patients at high risk for CHF.

Purpose of the Study:

  • To evaluate the predictive capability of the at-discharge Global Registry of Acute Coronary Events (GRACE) score for subsequent heart failure admissions in patients with ACS.
  • To determine if the GRACE score can identify patients who will develop CHF after an acute coronary event.

Main Methods:

  • A retrospective analysis of 1,956 patients admitted with ACS between June 1999 and September 2009.
  • Utilized five-year mortality and hospitalization data from a single center within the GRACE registry.
  • Defined CHF using the WHO International Classification of Diseases 10 code I50 and employed Cox models to estimate hazard ratios for CHF admission based on GRACE score quintiles, adjusting for relevant covariates.

Main Results:

  • Over a median follow-up of 3.8 years, 12% of patients were admitted with CHF.
  • Patients in the highest GRACE score quintile experienced significantly more CHF admissions (116 vs. 17) and a shorter time to first admission compared to the lowest quintile.
  • Each standard deviation increase in GRACE score was associated with a more than two-fold higher risk of CHF admission (adjusted HR 2.49).
  • The GRACE score demonstrated a C-statistic of 0.74 for predicting 1-year CHF admission.

Conclusions:

  • The at-discharge GRACE score is a significant predictor of heart failure admissions following acute coronary syndrome.
  • The GRACE score can be utilized to identify ACS patients at high risk for developing CHF.
  • Targeted clinical monitoring and therapeutic interventions can be implemented for high-risk ACS patients identified by the GRACE score.
Abstract

Keywords:
Heart failuremyocardial infarctionprognosis

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