A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program.
BACKGROUND
Effective risk stratification can inform clinical decision-making. Our objective was to derive and validate a risk score for in-hospital mortality in patients hospitalized with heart failure using American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) program data.


RESULTS
A cohort of 39 783 patients admitted January 1, 2005, to June 26, 2007, to 198 hospitals participating in GWTG-HF was divided into derivation (70%, n=27 850) and validation (30%, n=11 933) samples. Multivariable logistic regression identified predictors of in-hospital mortality in the derivation sample from candidate demographic, medical history, and laboratory variables collected at admission. In-hospital mortality rate was 2.86% (n=1139). Age, systolic blood pressure, blood urea nitrogen, heart rate, sodium, chronic obstructive pulmonary disease, and nonblack race were predictive of in-hospital mortality. The model had good discrimination in the derivation and validation datasets (c-index, 0.75 in each). Effect estimates from the entire sample were used to generate a mortality risk score. The predicted probability of in-hospital mortality varied more than 24-fold across deciles (range, 0.4% to 9.7%) and corresponded with observed mortality rates. The model had the same operating characteristics among those with preserved and impaired left ventricular systolic function. The morality risk score can be calculated on the Web-based calculator available with the GWTG-HF data entry tool.


CONCLUSIONS
The GWTG-HF risk score uses commonly available clinical variables to predict in-hospital mortality and provides clinicians with a validated tool for risk stratification that is applicable to a broad spectrum of patients with heart failure, including those with preserved left ventricular systolic function.
Peterson
Pamela N
PN
Denver Health Medical Center, Denver, CO, USA.
Rumsfeld
John S
JS
Liang
Li
L
Albert
Nancy M
NM
Hernandez
Adrian F
AF
Peterson
Eric D
ED
Fonarow
Gregg C
GC
Masoudi
Frederick A
FA
D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence; D006305:Health Status Indicators; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012372:ROC Curve; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left