title: GRACE score predicts heart failure admission following acute coronary syndrome.
abstract: BACKGROUND
  Congestive heart failure (CHF) is a common and preventable complication of acute coronary syndrome (ACS). Nevertheless, ACS risk scores have not been shown to predict CHF risk. We investigated whether the at-discharge Global Registry of Acute Coronary Events (GRACE) score predicts heart failure admission following ACS.
  
  
  RESULTS
  Five-year mortality and hospitalization data were obtained for patients admitted with ACS from June 1999 to September 2009 to a single centre of the GRACE registry. CHF was defined as any admission assigned WHO International Classification of Diseases 10 diagnostic code I50. The hazard ratio (HR) for CHF according to GRACE score was estimated in Cox models adjusting for age, gender and the presence of CHF on index admission. Among 1,956 patients, CHF was recorded on index admission in 141 patients (7%), and 243 (12%) were admitted with CHF over 3.8 median years of follow-up. Compared to the lowest quintile, patients in the highest GRACE score quintile had more CHF admissions (116 vs 17) and a shorter time to first admission (1.2 vs 2.0 years, HR 9.87, 95% CI 5.93-16.43). Per standard deviation increment in GRACE score, the instantaneous risk was more than two-fold higher (HR 2.28; 95% CI 2.02-2.57), including after adjustment for CHF on index admission, age and gender (HR 2.49; 95% CI 2.06-3.02). The C-statistic for CHF admission at 1-year was 0.74 (95% CI 0.70-0.79).
  
  
  CONCLUSIONS
  The GRACE score predicts CHF admission, and may therefore be used to target ACS patients at high risk of CHF with clinical monitoring and therapies.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, UK david.mcallister@ed.ac.uk.
authors.forename: David A
authors.initials: DA
authors.lastname: McAllister
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, UK.
authors.forename: Nynke
authors.initials: N
authors.lastname: Halbesma
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Carruthers
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Denvir
authors.affiliation: Centre for Cardiovascular Science, University of Edinburgh, UK.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Fox
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Heart failure; myocardial infarction; prognosis