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Prognostic Assessment of HLM Score in Heart Failure Due to Ischemic Heart Disease: A Pilot Study
Andrea D'Amato1, Paolo Severino1, Massimo Mancone1
1Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Insights
The HLM score effectively predicts cardiovascular death and heart failure hospitalization in ischemic heart failure patients, including those with acute coronary syndrome. This tool aids in prognostic stratification for better patient outcomes.
Area of Science:
- Cardiology
- Heart Failure Research
- Prognostic Biomarkers
Background:
- Ischemic heart disease (IHD) is the primary cause of heart failure (HF).
- Prognostic stratification of HF patients with ischemic etiology, especially post-acute coronary syndrome (ACS), is challenging due to clinical variability.
- The HLM score offers a potential tool for improved risk assessment in these patients.
Purpose of the Study:
- To evaluate the prognostic capability of the HLM score in patients with ischemic heart failure (HF).
- To assess the HLM score's predictive power in a subgroup of patients who developed HF following acute coronary syndrome (ACS).
Main Methods:
- An observational, prospective, single-center study enrolled 146 consecutive patients with ischemic HF.
- Patients were stratified into four HLM severity stages.
- Outcomes including cardiovascular death and heart failure hospitalization (HFH) were assessed at 6-month follow-up.
Main Results:
- The HLM stage significantly predicted cardiovascular death (p=0.01) and cardiovascular death/HFH (p=0.003) in the overall ischemic HF population.
- Cox regression confirmed HLM stage as an independent predictor of cardiovascular death and CV death/HFH (p=0.001).
- In the ACS subgroup, HLM stage strongly predicted cardiovascular death and CV death/HFH (p < 0.001).
Conclusions:
- The HLM score demonstrates prognostic value for predicting cardiovascular death and HFH in ischemic HF patients.
- This score is a promising tool for risk stratification in HF patients with ischemic etiology, including those post-ACS.
- Pathophysiology-based prognostic assessment using the HLM score can guide clinical management and improve patient outcomes.
Abstract:
Background: Ischemic heart disease (IHD) represents the main cause of heart failure (HF). A prognostic stratification of HF patients with ischemic etiology, particularly those with acute coronary syndrome (ACS), may be challenging due the variability in clinical and hemodynamic status. The aim of this study is to assess the prognostic power of the HLM score in a population of patients with ischemic HF and in a subgroup who developed HF following ACS. Methods: This is an observational, prospective, single-center study, enrolling consecutive patients with a diagnosis of ischemic HF. Patients were stratified according to the four different HLM stages of severity, and the occurrence of CV death, HFH, and worsening HF events were evaluated at 6-month follow-up. A sub-analysis was performed on patients who developed HF following ACS at admission. Results: The study included 146 patients. HLM stage predicts the occurrence of CV death (p = 0.01) and CV death/HFH (p = 0.003). Cox regression analysis confirmed HLM stage as an independent predictor of CV death (OR: 3.07; 95% IC: 1.54-6.12; p = 0.001) and CV death/HFH (OR: 2.45; 95% IC: 1.43-4.21; p = 0.001) in the total population of patients with HF due to IHD. HLM stage potentially predicts the occurrence of CV death (p < 0.001) and CV death/HFH (p < 0.001) in patients with HF following ACS at admission. Conclusions: Pathophysiological-based prognostic assessment through HLM score is a potentially promising tool for the prediction of the occurrence of CV death and CV death/HFH in ischemic HF patients and in subgroups of patients with HF following ACS at admission.
