A new simple chronic heart failure prognostic index based on five general parameters

Prognostic prediction in heart failure (HF) is challenging and no single marker has proven effective. We propose an index based on B-type natriuretic peptide (BNP) and four widely available parameters.

We retrospectively analyzed adult outpatients with chronic HF with systolic dysfunction followed from January 2012 to December 2020. The new proposed index was calculated based on 5 parameters measured at the index visit. BASIC index = (BNP*(age)²) / (serum sodium*hemoglobin*estimated glomerular filtration rate). Patients were followed-up until January 2023; the primary endpoint was all-cause mortality. A receiver operator curve was used to assess the association of the index with outcome; a cut-off was chosen based on the curve. We used a Cox-regression analysis to determine the prognostic value of the index. Adjustments were made considering established prognostic predictors.

We studied 1065 patients. Mean age was 71 years, 65.8 % were male, 45.3 % had ischemic HF and 47.2 % had severe systolic dysfunction. During a 47-months median follow-up, 545 patients died (51.2 %). Median BASIC index: 11.7 (3.5-33.7). The area under the curve was 0.73 (0.70-0.76) vs 0.69 (0.66-0.72) for BNP, p < 0.001. The best cut-off value was 9.3; sensitivity = 71.4 %, specificity = 62.3 %, positive predictive value = 66.5 and negative predictive value = 67.5 %. Patients with a BASIC index above 9.3 had a multivariate-adjusted HR of all-cause mortality = 2.70 (2.20-3.22).

The incorporation of age, hemoglobin, serum sodium, glomerular filtration rate and BNP in an index significantly improves prognostic prediction when compared to BNP alone. Patients with a BASIC index above 9.3 have an almost 3-fold higher death-risk.