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Risk stratification in heart failure with preserved ejection fraction: what is the best score?
Session:
Sessão de Comunicações Orais - Insuficiência Cardíaca
Speaker:
Maria Inês Fiúza Pires
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Inês Pires; João Miguel Santos; Hugo Da Silva Antunes; Maria Luisa Gonçalves; Joana Laranjeira Correia; José Costa Cabral; Inês Almeida
Abstract
<p>Background: There are many risk scores in patients (P) with heart failure (HF), but few are specific for HF with preserved ejection fraction (HFpEF) and few apply readily available variables. 3A3B Score, developed in Japanese HFpEF P, predicts their long-term prognosis. GWTG-HF score predicts in-hospital mortality (IHM) in American P with acute HF. AHEAD score estimates short- and long-term prognosis of Czech P with acute HF. This study compares risk prediction of these scores in HFpEF.</p> <p>Methods: All P admitted with acute HFpEF in a Cardiology Department for 7 years were included. Scores were obtained at admission. 3A3B (range 0-7) uses age ≥75 years (2 points), and albumin <3.7?g/dL, anemia, body mass index <22?kg/m<sup>2</sup>, BNP ≥300?pg/mL, and BUN ≥25?mg/dL (1 point each). GWTG-HF (range 0-100) considers race, age, systolic blood pressure, heart rate, BUN and sodium levels and chronic obstructive pulmonary disease. AHEAD (range 0-5) uses atrial fibrillation, anemia, age >70 years, creatinine >1.47 mg/dL and diabetes mellitus. IHM and all-cause mortality or hospitalization for HF at 24 months (FUevents) were evaluated. Statistical analysis used chi-square and independent-samples T tests, binary logistic and Cox proportional hazards regressions and ROC curves.</p> <p>Results: 478 P were studied (61.3% female, mean age 79.4±8.3years). Mean 3A3B, GWTG-HF and AHEAD scores were 3.4±1.6, 39.2±8.1 and 2.5±1, respectively. IHM was 3.4%.</p> <p>P who died had higher 3A3B than those who survived (4.8±1.2 vs 3.2±1.5, p<0.001), but their GWTG-HF (43.2±6.7 vs 39±8.1, p=0.065) and AHEAD (2.5±0.5 vs 2.5±1, p=0.572) scores were not statistically significant different. 3A3B predicted IHM (OR 2.486; p=0.001) unlike the other scores.</p> <p>60.3% P had FUevents and they had higher 3A3B (3.6±1.2 vs 2.4±1.7, p<0.001), GWTG-HF (39.4±8 vs 37.2±7.9, p=0.015) and AHEAD (2.7±1 vs 2.4±1.1, p=0.006) scores than those without FUevents. Unadjusted hazard ratio for occurrence of FUevents was 1.138 (p<0.001) for 3A3B, 1.024 (p=0.010) for GWTG-HF and 1.186 (p=0.007) for AHEAD.</p> <p>3A3B score had the best discriminatory power to predict IHM (AUC 0.791, 95%CI 0.704-0.862) and FUevents (AUC 0.702, 95%CI 0.598-0.793) – figure 1, and outperformed the other scores in predicting FUevents.</p> <p>Conclusion: 3A3B score predicted IHM and FUevents in HFpEF, and had better predictive power than GWTG-HF and AHEAD scores in FUevents. These results highlight the importance of developing risk prediction tools specific for HFpEF.</p>
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