SPC365

GWTG-HF score vs AHEAD score: which scores better?

Session: Posters (Sessão 2 - Écran 4) - Insuficiência Cardíaca 2 - Índices e Factores de Prognóstico
Speaker: Mariana da Silva Santos

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Mariana da Silva Santos; Margarida Figueiredo; Sofia b Paula; Helder Santos; Inês Almeida; Samuel Almeida; Luís Santos; João Tavares; Lurdes Almeida

<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;,serif">Introduction</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (IHM) in P admitted with AHF. The AHEAD scoring system is a simple tool that estimates short and long-term prognosis of P hospitalized with acute heart failure (AHF).&nbsp;</span></span></span></span><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;,serif">We aimed to validate AHEAD and GWTG-HF scores in a &ldquo;real world&rdquo; AHF population as predictors of IHM, post discharge early and late mortality (M) [1-month M (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;,serif">Methods</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Single-center retrospective study including P admitted AHF between 2010 and 2017. 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;,serif">Results</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Among the 300 P admitted with AHF included, mean age was 67.4&plusmn;12.6 years old, 72.7% were male, 66.9% had hypertension, 41% diabetes and 38% dyslipidaemia. Mean heart rate was 95.5&plusmn;27.5bpm, mean systolic blood pressure (SBP) was 131.2&plusmn;37.0mmHg, mean urea level at admission was 68.8&plusmn;40.7mg/dL, mean sodium level at admission was 137.6&plusmn;4.7mmol/L, mean glomerular filtration rate (GFR) was 57.1&plusmn;23.5ml/min and 35.3% were in Killip-Kimball class 4. Mean GWTG-HF was 41.7&plusmn;9.6 and mean AHEAD was 2.88&plusmn;1.1. Inotropes&rsquo; usage was necessary in 32.7% of the P, 11.3% of the P needed non-invasive ventilation, 8% needed invasive ventilation.</span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">IHM rate was 5%, 1mM was 8% and 1yM 27%.</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;,serif">Logistic regression confirmed that GWTG-HF was predictive of IHM (OR 1.12, p&lt;0.001, CI 1.05-1.19) and 1mM (OR 1.1, p=0.001, CI 1.04-1.16) with fair accuracy (area under curve (AUC) 0.774 and p=0.727, respectively) and 1yM (OR 1.08, p&lt;0.001, CI 1.04-1.11) with poor accuracy (p=0.672). On the other hand, AHEAD score was not predictive of IHM (p=0.063) or 1mM (p=0.128), but was predictive of 1yM (OR 1.41 p=0.005, CI 1.11-1.79) with poor accuracy (AUC=0.604).</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;,serif">The authors determined other predictor factors of 1yM (not included on the scores/included in one): lower SBP, higher urea, lower sodium, lower GFR, need of inotropes and KKC 4 (all p&lt;0.05). At multivariate regression, only inotropes&rsquo; usage was independently associated with 1yM (p=0.038, OR 1.9, CI 1.04-3.52).</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;,serif">Conclusion</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: GWTG-HF score was predictive of IHM and 1mM, with fair accuracy. AHEAD score failed these outcomes. Regarding 1yM, both scores were predictive, but with poor accuracy. When assessing long-term outcomes risk with these scores, other predictor factors should be taken in account.</span></span></span></span></p>