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Document Details : Title: Discharge risk scoring method for predicting mortality in hospitalized chronic heart failure patients with severe systolic dysfunction Author(s): A. Tokatli , K. Karauzum , D. Ural , C. Baydemir , G. Kozdag , U. Celikyurt , Y. Akay , O. Argan , I. Yilmaz , A. Vural Journal: Acta Cardiologica Volume: 70 Issue: 4 Date: 2015 Pages: 442-449 DOI: 10.2143/AC.70.4.3094654 Abstract : Objective: Prognostic risk stratification in heart failure is crucial to guide clinical decision-making. The aim of our study was to develop a prognostic discharge risk score model to predict all-cause mortality for chronic heart failure patients with multiple co-morbidities and severe systolic dysfunction. Methods and results: A multivariable logistic regression model was developed with the use of data on clinical, laboratory, imaging and therapeutic findings of 630 patients with advanced systolic heart failure. A risk score model was developed based on multiplying the β-coefficient number of each variable in the multivariable model. The model performance was evaluated by concordance index and internally validated by the bootstrapping method. 313 patients (49.7%) of the cohort died during a median follow-up duration of 54 months. Median age was 66 years, 37% were female, 26% had atrial fibrillation and 40% had diabetes mellitus. The mean left ventricular ejection fraction (EF) was 25 ± 10% and 264 patients (42%) had left ventricular EF ≤ 20%. Independent predictors of mortality were older than 70 years, orthopnoea, previous hospitalisations, lack of renin-angiotensin system inhibitor therapy at discharge, hyperuricaemia (> 7 mg/dl) and haemoglobin level (< 10 g/dL). Discharge risk score identified low-, intermediate- and high-risk individuals with 18%, 40% and 52% mortality rates, respectively. The risk score had a discrimination ability with a concordance index of 0.70. Conclusions: In a large heart failure cohort, including patients with severe systolic dysfunction and having multiple co-morbidities, a simple discharge risk score with non-invasive and easy-to-obtain variables during hospital admission represents a valuable tool for risk assessment. |
