SPC365

GRACE score vs GWTG-HF score: risk stratification 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
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<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). GRACE score estimates risk of death, including IHM and long-term mortality (M), 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 GRACE score in AHF and to compare GRACE and GWTG-HF scores as predictors of IHM, post discharge early and late M [1-month mortality (1mM) and 1-year M (1yM)], 1-month readmission (1mRA) and 1-year readmission (1yRA).</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 GRACE was 147.9&plusmn;30.2 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 patients 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%, 1mM was 8% and 1yM 27%. 6.3% of the patients were readmitted 1 month after discharge and 52.7% had at least one more admission in the year following 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 SBP (p=0,005), higher urea (p=0,001), lower sodium (p=0.005), PCI intervention (p=0,017), lower GFR (p&lt;0.001) and need of inotropes (0.001) were predictors of 1yM after discharge. P in KKC 4 had higher IHM (OR 8.13, p&lt;0.001), 1mM (OR 4.13, p=0.001) and 1yM (OR 1.96, p=0.011). KKC at admission did not predict readmission (either 1mRA or 1yRA, respectively p=0.887 and p=0.695). </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 a good predictor of IHM (OR 1.12, p&lt;0.001) but also 1mM (OR 1.1, p=0.001) and 1yM (OR 1.08, p&lt;0.001). GRACE also predicted IHM (OR 1.06, p&lt;0.001), 1mM (OR 1.04, p&lt;0.001) and 1yM (OR 1.03, p&lt;0.001). ROC curve analysis revealed that GRACE and GWTG-HF were accurate at predicting IHM (AUC 0.866 and 0.774, respectively), 1mM (AUC 0.779 and 0.727, respectively) and 1yM (AUC 0.676 and 0.672, respectively). Both scores failed at predicting 1mRA (GRACE p=0.463; GWTG-HF p=0.841) and 1yRA (GRACE p=0.244; GWTG-HF p=0.806).</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 predicted IHM, GRACE performing better. Their performance predicting post-discharge mortality outcomes was poorer.</span></span></span></span></p>

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