Acute heart failure: predicting early in-hospital outcomes

Abstract

\n \n \n Type of funding sources: None.\n \n \n \n Patients (P) with acute heart failure (AHF) are a heterogeneous population. Risk stratification at admission may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M) of P admitted with AHF. ACTION ICU score is validated to estimate the risk of complications requiring ICU care in non-ST elevation acute coronary syndromes.\n \n \n \n To validate ACTION-ICU score in AHF and to compare ACTION-ICU to GWTG-HF as predictors of in-hospital M (IHM), early M [1-month mortality (1mM)] and 1-month readmission (1mRA), 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 Among the 300 P admitted with AHF included, mean age was 67.4\u2009±\u200912.6 years old and 72.7% were male. Systolic blood pressure (SBP) was 131.2\u2009±\u200937.0mmHg, glomerular filtration rate (GFR) was 57.1\u2009±\u200923.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. ACTION-ICU score was 10.4\u2009±\u20092.3 and GWTG-HF was 41.7\u2009±\u20099.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV). IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge.\n Older age (p\u2009<\u20090.001), lower SBP (p\u2009=\u20090,035) and need of inotropes (p\u2009<\u20090.001) were predictors of IHM in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p\u2009<\u20090.001). Older age (OR 1.06, p\u2009=\u20090.002, CI 1.02-1.10), lower SBP (OR 1.01, p\u2009=\u20090.05, CI 1.00-1.02) and lower left ventricle ejection fraction (LVEF) (OR 1.06, p\u2009<\u20090.001, CI 1.03-1.09) were predictors of need of NIV. None of the variables were predictive of IV. LVEF (OR 0.924, p\u2009<\u20090.001, CI 0.899-0.949), lower SBP (OR 0.80, p\u2009<\u20090.001, CI 0.971-0.988), higher urea (OR 1.01, p\u2009<\u20090.001, CI 1.005-1.018) and lower sodium (OR 0.92, p\u2009=\u20090.002, CI 0.873-0.971) were predictors of inotropes’ usage.\n Logistic regression showed that GWTG-HF predicted IHM (OR 1.12, p\u2009<\u20090.001, CI 1.05-1.19), 1mM (OR 1.10, p\u2009=\u20091.10, CI 1.04-1.16) and inotropes’s usage (OR 1.06, p\u2009<\u20090.001, CI 1.03-1.10), however it was not predictive of 1mRA, need of IV or NIV. Similarly, ACTION-ICU predicted IHM (OR 1.51, p\u2009=\u20090.02, CI 1.158-1.977), 1mM (OR 1.45, p\u2009=\u20090.002, CI 1.15-1.81) and inotropes’ usage (OR 1.22, p\u2009=\u20090.002, CI 1.08-1.39), but not 1mRA, the need of IV or NIV. ROC curve analysis revealed that GWTG-HF score performed better than ACTION-ICU regarding IHM (AUC 0.774, CI 0.46-0-90 vs AUC 0.731, CI 0.59-0.88) and 1mM (AUC 0.727, CI 0.60-0.85 vs AUC 0.707, CI 0.58-0.84).\n \n \n \n In our population, both scores were able to predict IHM, 1mM and inotropes’s usage.\n