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The ABCDE Score: A Simple Tool for Predicting 3-Month Mortality in Acute Heart Failure Patients
Session:
SESSÃO DE POSTERS 21 - IC E PROGNÓSTICO
Speaker:
Diogo Ferreira
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Diogo Rosa Ferreira; Ana Abrantes; João Lucas Temtem; Fátima Salazar; Ana Francês; Rafael Santos; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto Pinto; Dulce Brito; João Agostinho
Abstract
<h3 style="text-align:justify"><span style="font-size:13pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Acute heart failure (HF) is a leading cause of morbidity and mortality, with diverse clinical presentations complicating risk prediction and the identification of patients needing hospitalization. Early recognition of high-risk patients is crucial for guiding management and improving outcomes. This study aimed to identify clinical and biomarker-based predictors of 3-month mortality in HF patients and to develop a simple risk score to aid in mortality risk stratification and admission decisions.</span></span></span></h3> <h3 style="text-align:justify"><span style="font-size:13pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">This retrospective, single-center study included 187 consecutive patients diagnosed with acute HF who presented to a tertiary care emergency department between January and March of 2023. Cox regression and Receiver operating characteristics (ROC) analysis were used to identify predictors of short-term mortality and to develop a scoring system for identifying high-risk patients who may benefit from inpatient care.</span></span></span></h3> <h3 style="text-align:justify"><span style="font-size:13pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The cohort had a mean age of 82.4 years, with 62% of female patients and a baseline mean left ventricular ejection fraction of 50%. Among patients, 28% presented with peripheral congestion, 13%, with pulmonary congestion and 59% with both. Of the total, 57% were hospitalized, and 27% had died by the 3-month follow-up. </span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Significant predictors of mortality included atrial fibrillation (HR: 1.7; 95% CI: 1.3–2.87; p=0.04), estimated glomerular filtration rate (eTGF) <35 mL/min/1.73 (HR: 1.8; 95% CI: 1.3–4.0, p=0.004), NT-proBNP level >8000 pg/mL (HR: 4.0; 95% CI: 2.1–7.7; p<0.001), T-troponin >115 ng/L (HR: 5.2; 95% CI: 2.7–10.1; p<0.001), and a furosemide dose >40 mg (HR: 2.4; 95% CI: 1.4–3.8; p=0.03). Based on these factors, the </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>ABCDE</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> scoring system was developed, assigning:</span></span></span></h3> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">- 1 point for </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>A</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">trial fibrillation or Creatinine clearance <35 mL/min;</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">- 2 points for NT-pro</span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>B</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">NP >8000 pg/mL;</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">- 2.5 points for </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>C</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">ardiac damage, defined by T-troponin >115 ng/L</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">- 1.5 points for furosemide </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>D</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">ose >40 mg;</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">- 1 point for </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>E</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">GFR <35 ml/min/1.73</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">We calculated individual scores for each patient and identified an optimal cutoff point to best predict 3-month mortality risk. Patients with a score greater than 3 were found to have a 4.3-fold higher risk of mortality at 3 months (HR: 4.3; 95% CI 2.4-7.5, p<0.001). Among patients with a score greater than 3, 53% of those discharged died, while only 28% of those admitted died during the follow-up period.</span></span></span></p> <h3 style="text-align:justify"><span style="font-size:13pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong></span></span></span><br /> <span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The ABCDE scoring system effectively stratifies mortality risk in acute HF patients using key and readily available predictors such as atrial fibrillation, impaired renal function, elevated NT-proBNP and T-troponin and high usual furosemide doses. Patients with scores >3 had significantly increased 3-month mortality, with discharged patients showing a higher mortality rate than those admitted. This scoring system provides clinicians with a practical tool for identifying high-risk patients that can benefit from being admitted. </span></span></span></h3> <p> </p>
Slides
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