The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure.
BACKGROUND
The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF).


METHODS
We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ≤ 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive.


RESULTS
During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ≤ 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (≤6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ≤ 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip.


CONCLUSIONS
Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF.
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari. Electronic address: domenico.scrutinio@fsm.it.
Domenico
D
Scrutinio
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan; San Raffaele Scientific Institute and University, Milan.
Enrico
E
Ammirati
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari.
Pietro
P
Guida
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari.
Andrea
A
Passantino
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy.
Rosa
R
Raimondo
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan.
Valentina
V
Guida
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, IRCCS, Institute of Tradate, Varese, Italy.
Simona
S
Sarzi Braga
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan.
Paolo
P
Canova
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari.
Filippo
F
Mastropasqua
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan.
Maria
M
Frigerio
Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari.
Rocco
R
Lagioia
Cardiothoracic and Vascular Department, Niguarda Ca' Granda Hospital, Milan.
Fabrizio
F
Oliva
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D018450:Disease Progression; D004232:Diuretics / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D007558:Italy; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000628:therapy
D002316:Cardiotonic Agents; D004232:Diuretics; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
ADHF/NT-proBNP score; Seattle Heart Failure Model score; advanced decompensated heart failure; risk stratification