SPC365

Predicting early in-hospital outcomes in acute heart failure

Session: Posters - D. Heart Failure
Speaker: Sofia B. Paula

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Sofia B. Paula
<p style="text-align:center">&nbsp;</p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Introduction</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">: Risk stratification at admission of patients (P) with acute heart failure (AHF) may help predict in-hospital complications and needs. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (M). ACTION ICU score estimates the risk of complications requiring ICU care in NSTEMI.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Objective</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">: Validate ACTION-ICU score in AHF and compare ACTION-ICU and GWTG-HF scores as predictors of in-hospital M (IHM), post discharge early M [1-month mortality (1mM)] and 1-month readmission (1mRA).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Methods</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">: 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. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Results</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">: 300 P were included, mean age was 67.4&plusmn;12.6 yo. Mean systolic blood pressure (SBP) was 131.2&plusmn;37.0mmHg, BUN 68.8&plusmn;40.7mg/dL, Na+ 137.6&plusmn;4.7mmol/L, and mean GFR was 57.1&plusmn;23.5ml/min. 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean ACTION-ICU score was 10.4&plusmn;2.3 and mean GWTG-HF was 41.7&plusmn;9.6. Inotropes&rsquo; usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation (NIV), 8% needed invasive ventilation (IV).</span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">IHM rate was 5% and 1mM was 8%. 6.3% of the P were readmitted 1 month after discharge. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Older age (p&lt;0.001), lower SAP (p=0,035) and need of inotropes (p&lt;0.001) were predictors of IHM in our population. P in KKC 4 had higher IHM (OR 8.13, p&lt;0.001). Older age (OR 1.06, p=0.002), lower SBP (OR 1.01, p=0.05) and lower LVEF (OR 1.06, p&lt;0.001) were predictors of need of NIV. None were predictive of need of IV. LVEF (OR 0.924, p&lt;0.001), lower SBP (OR 0.80, p&lt;0.001), higher urea (OR 1.01, p&lt;0.001) and lower sodium (OR 0.92, p=0.002) were predictors inotropes&rsquo; usage.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">GWTG-HF was able to predict IHM (OR 1.12, p&lt;0.001, CI 1.05-1.19), 1mM (OR 1.10, p=1.10, CI 1.04-1.16) and inotropes&rsquo;s usage (OR 1.06, p&lt;0.001, CI 1.03-1.10), but it was not predictive of 1mRA, need of IV/NIV. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Similarly, ACTION-ICU was able to predict IHM (OR 1.51, p=0.02, CI 1.158-1.977), 1mM (OR 1.45, p=0.002, CI 1.15-1.81) and inotropes&rsquo; usage (OR 1.22, p=0.002, CI 1.08-1.39), but not 1mRA, need of IV/NIV. ROC curve analysis revealed that GWTG-HF score performed slightly better than ACTION-ICU when predicting 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).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">Conclusion</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">: Both scores were able to predict IHM, 1mM and inotropes&rsquo;s usage.</span></span></span></span></p>