GRACE score vs GWTG-HF score: risk stratification in acute heart failure

Abstract

\n \n \n Type of funding sources: None.\n \n \n \n Patients (P) with acute heart failure (AHF) are a heterogeneous population. Therefore, early risk stratification at admission is essential. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (IHM) of patients admitted with AHF. GRACE score estimates risk of death, including IHM and long-term mortality (M), in non-ST elevation acute coronary syndromes.\n \n \n \n To validate GRACE score in AHF and to compare GRACE and GWTG-HF scores as predictors of IHM, post discharge early and late M [1-month mortality (1mM) and 1-year M (1yM)], 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data.\n \n \n \n Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis.\n \n \n \n 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean GRACE was 147.9\u2009±\u200930.2 and mean GWTG-HF was 41.7\u2009±\u20099.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the patients needed non-invasive ventilation, 8% needed invasive ventilation. IHM rate was 5%, 1mM was 8% and 1yM 27%. 6.3% of the patients were readmitted 1 month after discharge and 52.7% had at least one more admission in the year following discharge.\n Older age (p\u2009<\u20090.001), lower SBP (p\u2009=\u20090,005), higher urea (p\u2009=\u20090,001), lower sodium (p\u2009=\u20090.005), previous history of percutaneous coronary intervention (p\u2009=\u20090,017), lower GFR (p\u2009<\u20090.001) and need of inotropes (0.001) were predictors of 1yM after discharge in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p\u2009<\u20090.001), higher 1mM (OR 4.13, p\u2009=\u20090.001) and higher 1yM (OR 1.96, p\u2009=\u20090.011). On the other hand, KKC at admission did not predict readmission (either 1mRA or 1yRA, respectively p\u2009=\u20090.887 and p\u2009=\u20090.695).\n Logistic regression confirmed that GWTG-HF was a good predictor of IHM (OR 1.12, p\u2009<\u20090.001, CI 1.05-1.19) but also 1mM (OR 1.1, p\u2009=\u20090.001, CI 1.04-1.16) and 1yM (OR 1.08, p\u2009<\u20090.001, CI 1.04-1.11). GRACE also showed the ability to predict IHM (OR 1.06, p\u2009<\u20090.001, CI 1.03-1.10), 1mM (OR 1.04, p\u2009<\u20090.001, CI 1.02-1.06) and 1yM (OR 1.03, p\u2009<\u20090.001, CI 1.01-1.03). ROC curve analysis revealed that GRACE and GWTG-HF were accurate at predicting IHM (AUC 0.866 and 0.774, respectively), 1mM (AUC 0.779 and 0.727, respectively) and 1yM (AUC 0.676 and 0.672, respectively). Both scores failed at predicting 1mRA (GRACE p\u2009=\u20090.463; GWTG-HF p\u2009=\u20090.841) and 1yRA (GRACE p\u2009=\u20090.244; GWTG-HF p\u2009=\u20090.806).\n \n \n \n This study confirms that, in our population, both scores were excellent at predicting IHM, with GRACE performing better.\xa0Although both scores were able to predict post-discharge mortality outcomes, their performance was poorer.\n