Predictors of clinical outcomes in acute decompensated heart failure: Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure outcome models

Prateeti Khazanie*, Gretchen M. Heizer, Vic Hasselblad, Paul W. Armstrong, Robert M. Califf, Justin Ezekowitz, Kenneth Dickstein, Wayne C. Levy, John J. V. McMurray, Marco Metra, W. H. Wilson Tang, John R. Teerlink, Adriaan A. Voors, Christopher M. O'Connor, Adrian F. Hernandez, Randall Starling

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

33 Citations (Scopus)

Abstract

Background Patients hospitalized for acute decompensated heart failure (ADHF) are at high risk for early mortality and rehospitalization. Risk stratification of ADHF using clinically available data on admission is increasingly important to integrate with clinical pathways. Our goal was to create a simple method of screening patients upon admission to identify those with increased risk of future adverse events.

Methods Using ASCEND-HF, a pragmatic clinical trial conducted in 398 sites globally, we developed and validated logistic regression risk models for (a) 30-day mortality/HF rehospitalization, (b) 30-day mortality/all-cause rehospitalization, (c) 30-day all-cause mortality, and (d) 180-day all-cause mortality. Fifty-one candidate variables were evaluated based on prior publications and clinical review. Final models were selected based on stepwise selection with entry and a staying criterion of P <.01. The 30-day mortality model was externally validated, and coefficients were converted to an additive risk score.

Results Among 7,141 patients, the median age was 67 years, 34% were female, and 80% had a left ventricular ejection fraction

Conclusions Commonly available clinical variables provide simple risk stratification for clinical outcomes among patients with ADHF, and these models may be considered for integration into routine clinical care.

Original languageEnglish
Pages (from-to)290-297.e1
Number of pages9
JournalAmerican Heart Journal
Volume170
Issue number2
DOIs
Publication statusPublished - Aug-2015

Keywords

  • NATIONAL REGISTRY ADHERE
  • WORSENING RENAL-FUNCTION
  • RISK STRATIFICATION
  • OPTIMIZE-HF
  • MORTALITY
  • IMPACT
  • TRIAL
  • HYPONATREMIA
  • ADMISSION
  • SURVIVAL

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