title: A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score.
abstract: BACKGROUND
  Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalisation.
  
  
  OBJECTIVE
  The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population.
  
  
  METHODS
  Individual patient data meta-analyses of prospective cohort studies.
  
  
  METHODS
  Seven prospective cohorts with in total 1301 patients.
  
  
  METHODS
  Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge.
  
  
  METHODS
  The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge.
  
  
  RESULTS
  The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age ≥75 years, peripheral oedema, systolic blood pressure ≤115 mm Hg, hyponatremia at admission, serum urea of ≥15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p<0.001). A simplified model was obtained from the final Cox regression model by assigning weights to individual risk markers proportional to their relative risks. The risk score we designed identified four clinically significant subgroups. The pattern of increasing event rates with increasing score was confirmed in the validation group (BOT-AcuteHF, n=325, p<0.001).
  
  
  CONCLUSIONS
  In patients hospitalised for ADHF, the addition of the discharge NT-proBNP values as well as the change in NT-proBNP to known risk markers, generates a relatively simple yet robust discharge risk score that importantly improves the prediction of adverse events.
authors.affiliation: Heart failure Research Center & Department of Cardiology, Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands.
authors.forename: Khibar
authors.initials: K
authors.lastname: Salah
authors.forename: Wouter E
authors.initials: WE
authors.lastname: Kok
authors.forename: Luc W
authors.initials: LW
authors.lastname: Eurlings
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.forename: Joana M
authors.initials: JM
authors.lastname: Pimenta
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.forename: Valerio
authors.initials: V
authors.lastname: Verdiani
authors.forename: Luca
authors.initials: L
authors.lastname: Bettari
authors.forename: Valentina
authors.initials: V
authors.lastname: Lazzarini
authors.forename: Peter
authors.initials: P
authors.lastname: Damman
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Yigal M
authors.initials: YM
authors.lastname: Pinto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Heart Failure