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A simple score for early risk stratification in acute heart failure
A Xanthopoulos1, G Giamouzis1, K Tryposkiadis2
1University General Hospital of Larissa, Department of Cardiology, Larissa, Greece.
Insights
A new Acute Heart Failure Risk Score (AHFRS) simplifies early risk stratification. This accessible score accurately identifies patients at high risk for adverse outcomes within one year.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Acute Heart Failure
Background:
- Existing acute heart failure (AHF) risk scores are often complex and cumbersome for clinical use.
- There is a need for a simple and effective tool for early risk stratification in AHF patients.
Purpose of the Study:
- To develop and validate a simple Acute Heart Failure Risk Score (AHFRS) for early risk stratification.
- To assess the discriminative ability of the AHFRS in predicting 1-year mortality or rehospitalization in AHF patients.
Main Methods:
- A prospective derivation cohort (PDC) and a retrospective validation cohort (RVC) were utilized.
- Clinical, echocardiographic, and laboratory data were collected at admission.
- The study endpoint was defined as all-cause death or heart failure rehospitalization within 1 year.
Main Results:
- Independent predictors for the endpoint were identified as: absence of hypertension history, presence of myocardial infarction history, and admission red cell distribution width (RDW) ≥15%.
- The AHFRS was developed assigning points for these factors, with higher scores indicating greater risk.
- The AHFRS demonstrated high discriminative ability in both the PDC (AUC 0.80) and RVC (AUC 0.82).
Conclusions:
- The developed AHFRS is easily obtainable upon admission for acute heart failure.
- The AHFRS accurately stratifies risk in AHF patients, aiding in early clinical decision-making.
Introduction:
The use of many acute heart failure (AHF) risk scores is cumbersome. We therefore developed a simple AHF risk score (AHFRS) for early risk stratification.
Methods:
The study consisted of a prospective derivation cohort (PDC; N=104; age, 77[21] years; LVEF (%), 35[29]) and a retrospective validation cohort (RVC; N=141; age, 76[15] years; LVEF (%), 35[25]). Clinical, echocardiography and laboratory assessment was performed at admission. The study end-point was death from any cause or HF-rehospitalization at 1year.
Results:
In the PDC 46 (44.2%) patients experienced the end-point. Independent prognostic factors of outcome were hypertension (HTN) history, myocardial infarction (MI) history, and admission red cell distribution width (RDW). Multivariate logistic regression indicated 8-, 4-, and 3-times higher odds ratio for development of study end-point in patients without a HTN history, with MI history, and RDW≥15% (median) respectively. Thus in AHFRS, 2 points were assigned for absence of HTN history, 1 point for presence of MI history, and 1 point for RDW values ≥15% (0 best possible, whereas 4 worst possible score). The AHFRS identified patients who developed the end-point in the PDC with an area under the ROC curve (AUC) of 0.80 [95% C.I.: (0.71, 0.87)] denoting a high discriminative ability. These findings were confirmed in the RVC, in which the endpoint occurred in 52 (36.9%) patients and the AUC for the AHFRS was 0.82 [95% C.I.: (0.73, 0.89)].
Conclusions:
AHFRS is easily obtained at admission and accurately risk stratifies AHF patients.
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