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I NEED HELP: from the acronym to the risk score for predicting adverse outcomes in chronic heart failure with reduced ejection fraction
Session:
Comunicações Orais (Sessão 26) - Insuficiência Cardíaca 4 - Vários Tópicos
Speaker:
Mariana Sousa Paiva
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Sousa Paiva; Daniel a. Gomes; Sara Guerreiro; Bruno Rocha; Rita Bello; Sérgio Maltês; Gonçalo l. Cunha; Catarina Brízido; Christopher Strong; Pedro Freitas; António Tralhão; Carlos Aguiar; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Background</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black">Although many risk scores for patients with heart failure (HF) have been proposed, the majority comprises innumerous variables, hampering their regular use. I NEED HELP is a simple acronym created to support the physician’s referral to a HF specialist. The aim of this study was to convert the acronym into an easily appliable risk score for ambulatory patients with chronic HF and reduced ejection fraction (HFrEF).</span></span></span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Methods</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black">Single-center retrospective cohort including consecutive patients with HFrEF (<50%) who underwent both transthoracic echocardiography and cardiac MRI from 2018-2020. </span></span></span></span></p> <p style="text-align:justify"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black"><span style="font-size:12pt">The acronym was transformed into the following variables: (I) need for intravenous inotropes; (N) NYHA functional class III-IV or NT-proBNP ≥ 1000pg/mL; (E</span><sub>rh</sub><span style="font-size:12pt">) renal dysfunction (GFR ≤ 30 mL/min/1.73m</span><sup>2</sup><span style="font-size:12pt"> by MDRD formula) or hepatic dysfunction (serum total bilirubin ≥ 1.8 mg/dL; (E</span><span style="font-size:13.3333px">ef</span><span style="font-size:12pt">) EF ≤ 30%; (D) appropriate defibrillator shocks; (H) more than one HF hospitalization in the previous year; (E<sub>d</sub>) combination of diuretics; (L) systolic blood pressure (SBP) ≤ 90 mmHg or heart rate (HR) ≥100 bpm; (P) intolerance to betablockers or renin angiotensin aldosterone inhibitors. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black">The primary outcome was a composite of HF hospitalization and all-cause mortality. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times"><span style="color:black">Cox Regression analysis was performed to explore the relationship between variables and outcomes. A scoring system was developed giving one point to each variable of the acronym.</span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Results</span></strong><span style="font-family:Times">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">A total of 200 patients were included (median age 66 years (IQR: 57-74), 74% male, 65% in NYHA II-III), of whom 66% had HF for more than 18 months. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">Over a mean follow-up of 25±12 months, a primary outcome occurred in 56 patients (28%). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:Times">The score median was 1 point (IQR: 0-2) and 58 patients had 0 points. Cox Regression analysis applied to the model confirmed its prognostic value (hazard ratio 1.5 for each point, p<0.001). The model exhibited good discriminative power, with a C-statistic of </span><span style="font-family:Times">0.7</span><span style="font-family:Times">8</span> <span style="font-family:Times">(</span><span style="font-family:Times">95%CI 0.7</span><span style="font-family:Times">1</span><span style="font-family:Times">-0.8</span><span style="font-family:Times">) – <strong>fig. 1A</strong>. Thereafter, the sample was stratified in 3 groups: low risk – 0 points; moderate risk – 1 point; high risk – 2+ points. Mean survival according to the predefined groups, in months, was 44 [95%CI 41-46] for the low-risk group, 37 [95%CI 33-41] for the moderate-risk group and 23 [95%CI 19-28] for the high-risk group (log-rank <0.001) – <strong>fig. 1B</strong>.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:Times">Conclusion</span></strong><span style="font-family:Times">: </span></span></span></p> <p><span style="font-size:12.0pt"><span style="font-family:Times">This is the first validation of the acronym “I NEED HELP” in a real-world population of patients with HFrEF. This new risk score “I NEED HELP” is simple to apply and strongly predicts adverse outcomes in HFrEF.</span></span></p>
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