title: EAARN score, a predictive score for mortality in patients receiving cardiac resynchronization therapy based on pre-implantation risk factors.
abstract: OBJECTIVE
  The beneficial effects of CRT in patients with advanced heart failure, wide QRS, and low LVEF have been clearly established. Nevertheless, mortality remains high in some patients. The aims of our study were to identify the predictors of mortality in patients treated with CRT and to design a risk score for mortality.
  
  
  RESULTS
  A cohort of 608 consecutive patients treated with CRT from 2000 to 2011 in our centre was prospectively analysed. Baseline clinical and echocardiography variables were analysed and mortality data were collected. During a mean follow-up of 36.2 ± 29.2 months, 174 patients died: 123/174 (71%) due to cardiovascular causes, 25/174 (14%) non-cardiac causes, and 26/174 (15%) unknown aetiology. In a multivariate analysis the predictors of mortality were NYHA class IV [hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.7-3.7, P < 0.001], glomerular filtration rate (GFR) <60 mL/min/1.73 m2 (HR 1.61, 95% CI 1.14-2.30, P = 0.008), AF (HR 1.67, 95% CI 1.19-2.3, P = 0.01), age ≥70 years (HR 1.44, (95% CI 1.04-2.00, P = 0.02), and LVEF <22% (HR 1.83, 95% CI 1.33-2.52, P ≤ 0.001). The EAARN score (EF, Age, AF, Renal dysfunction, NYHA class IV) summarizes the predictors. Each additional predictor increased the mortality: one predictor, HR 3.28 (95% CI 1.37-7.8, P = 0.008); two, HR 5.23 (95% CI 2.24-12.10, P < 0.001); three, HR 9.63 (95% CI 4.1-22.60, P < 0.001); and four or more, HR 14.38 (95% CI 5.8-35.65, P < 0.001).
  
  
  CONCLUSIONS
  The predictors of mortality have a significant add-on predictive effect on mortality. The EAARN score could be useful to stratify the prognosis of CRT patients.
authors.affiliation: Thorax Institute, Cardiology Department, Hospital Clinic, Universitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
authors.forename: Malek
authors.initials: M
authors.lastname: Khatib
authors.forename: José M
authors.initials: JM
authors.lastname: Tolosana
authors.forename: Emilce
authors.initials: E
authors.lastname: Trucco
authors.forename: Roger
authors.initials: R
authors.lastname: Borràs
authors.forename: Angeles
authors.initials: A
authors.lastname: Castel
authors.forename: Antonio
authors.initials: A
authors.lastname: Berruezo
authors.forename: Adelina
authors.initials: A
authors.lastname: Doltra
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
authors.forename: Elena
authors.initials: E
authors.lastname: Arbelo
authors.forename: Maria
authors.initials: M
authors.lastname: Matas
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada
authors.forename: Lluís
authors.initials: L
authors.lastname: Mont
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D058406:Cardiac Resynchronization Therapy; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Age; Atrial fibrillation; Cardiac resynchronization therapy; Ejection fraction; Glomerular filtration rate; Mortality; NYHA functional class