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ECHO-AHF score, a predictive model of in-hospital and long-term mortality in heart failure
Session:
Painel 1 - Insuficiência Cardíaca 9
Speaker:
João Miguel Santos
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Miguel Santos; Inês Pires; Luísa Gonçalves; Joana Laranjeira Correia; Hugo Da Silva Antunes; Inês Almeida; Emanuel Correia; José Costa Cabral
Abstract
<p><strong>Introduction</strong></p> <p>Patients hospitalized due to heart failure (HF) compose a heterogeneous population whose prognosis is difficult to forecast. The purpose of this study was to create a model based on echocardiographic parameters that could predict mortality and/or rehospitalization risk in different stages of HF course.</p> <p> </p> <p><strong>Methods </strong></p> <p>Retrospective analysis of 247 patients admitted for decompensated HF. The variables pulmonary artery systolic pressure (PSAP), left atria diameter (LAD), E/e’ ratio and left ventricle ejection fraction (LVEF) measured by Simpson’s biplane method were selected for score inclusion. Mann-Whitney U was used for univariate analysis. Subgroups were created for each variable, according to literature reference values. For each subgroup, an <em>odds ratio </em>(OR) for the risk of in-hospital mortality (IHM) was calculated, and a numerical value proportional to the OR was subsequently attributed. Normal reference values for these variables were classified with 0 points. A score was created, ranging from 0-37 points, corresponding to the sum of the classification attributed to each variable (ECHO-AHF score = points of LAD + PSAP + EF + E/e’ subgroups). ROC curve analysis was then performed to evaluate the predictive value of the score for IHM. Kaplan-Meyer survival plots and Cox-regression were used to assess mortality (24MM) and combined outcome of HF rehospitalization or death at 24 months (24HM).</p> <p> </p> <p><strong>Results</strong></p> <p>Mean patient age was 77±10y; 53% were men. Mean LVEF was 48% ±16, mean LAD 48.2 mm ±9.1, mean PSAP 46 mmHg ±14, mean E/e’ 16 ±7. 33% had LVEF<40%. IHM, 24MM and 24HM were 3%, 18.6% and 60.9%, respectively.</p> <p>A statistically significant association between IHM and PSAP (p<0.001), LAD (p=0.03), LVEF (p=0.02) and E/e´ ratio (p=0.05) was found on univariate analysis.</p> <p>ROC curve analysis revealed an AUC of 0.778 (p=0.004) for ECHO-AHF score, regarding IHM. The cut-off point with the most sensitivity (S) and specificity (E) obtained using Youden index (IY=0,4851) was 16 (S≈71%, E≈73%). Analysis of mortality by score interval revealed an IHM of 0%, 1.6%, 7.8% and 20%, respectively, for intervals 0-7, 8-16, 17-24 and >24. An ECHO-AHF score <8 predicted in-hospital survival in all patients. </p> <p>Kaplan Meyer survival analysis by subgroup (ECHO-AHF ≤16 or >16) revealed significant differences in 24MM (29.4% vs 15.4%, χ<sup>2</sup>= 5.807, p= 0.016).</p> <p>Cox-regression analysis demonstrated that ECHO-AHF score is an independent prognosis marker of 24MM (HR: 1.067, p=0.05) and 24HM (HR: 1.057, P=0.005) after adjustment for other variables, such as renal function, age and pulmonary disease.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>ECHO-AHF score is an accurate and simple predictive model of IHM, 24MM and 24HM. Its use may help to identify patients with a very high risk of in-hospital and long term-mortality, in need of specialized care, and those patients with very low risk of death, who might be candidates for early discharge or lenient follow-up.</p>
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