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The Prognostic Accuracy of Get With The Guidelines-Heart Failure Score Alone and with Lactate Among Acute Symptomatic
Buğra İlhan1, Göksu Bozdereli Berikol2, Halil Doğan3
1Department of Emergency Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Türkiye.
Insights
The Get With The Guidelines-Heart Failure (GWTG-HF) score, especially when combined with lactate (GWTG-HF+L), accurately predicts mortality in acute heart failure (HF) patients. Other scores also improve with lactate addition for better prognostic accuracy.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Prognostics
Background:
- Acute symptomatic heart failure (HF) presents a significant mortality risk.
- Accurate prognostic tools are crucial for timely intervention in HF patients.
Purpose of the Study:
- To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI).
- To assess the added value of lactate levels to these scores in predicting mortality in acute symptomatic HF.
Main Methods:
- Retrospective cohort study of 368 adult patients with acute symptomatic HF.
- Inclusion criteria: diagnosis of acute symptomatic HF, age >18 years.
- Primary endpoint: in-hospital mortality; secondary endpoints: 24-hour and 30-day mortality.
Main Results:
- The GWTG-HF score demonstrated strong predictive accuracy for in-hospital, 24-hour, and 30-day mortality (AUCs 0.807, 0.844, 0.765).
- The GWTG-HF score combined with lactate (GWTG-HF+L) showed superior performance (AUCs 0.872, 0.936, 0.801).
- Incorporating lactate improved the prognostic performance of SI, MSI, and Age-SI for all mortality outcomes.
Conclusions:
- The GWTG-HF score and GWTG-HF+L score offer acceptable discriminatory power for mortality in acute symptomatic HF.
- Lactate levels enhance the prognostic value of GWTG-HF, SI, MSI, and Age-SI in this patient population.
- These scores, particularly when augmented with lactate, can aid in predicting mortality in acute HF.
Background:
To evaluate the prognostic accuracy of the Get With The Guidelines-Heart Failure (GWTG-HF) score, Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (Age-SI) alone and with lactate in patients with acute symptomatic heart failure (HF).
Methods:
A retrospective cohort study was conducted in the emergency department of a tertiary hospital between January 1, 2019, and December 31, 2019. Patients aged >18 years and diagnosed with acute symptomatic HF were consecutively included in the study. Patients referred from another center and missing medical records were excluded. Arrival type, vital parameters, demographic characteristics, comorbid diseases, consciousness status, laboratory results, and outcomes of the patients were recorded. The primary endpoint of the study was in-hospital mortality.
Results:
A total of 368 patients were included in the final analysis. The in-hospital mortality rate of the patients was 7.6%. The GWTG-HF score outperformed other scores in predicting in-hospital, 24-hour, and 30-day mortality (area under the curve (AUC) = 0.807, 0.844, and 0.765, P <.001, respectively). The overall performance of the GWTG-HF score with lactate (GWTG-HF+L) was better in predicting in-hospital, 24-hour, and 30-day mortality than the original GWTG-HF score (AUC = 0.872, 0.936, and 0.801, P <.001, respectively). Adding lactate values to the SI, MSI, and Age-SI improved their overall performance for all 3 outcomes.
Conclusion:
Both the GWTG-HF and GWTG-HF+L scores have acceptable discriminatory power in patients with acute symptomatic HF. The GWTG-HF score, SI, MSI, and Age-SI can be used together with lactate to predict mortality in patients with acute HF.
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