title: Predictors of clinical outcomes in acute decompensated heart failure: Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure outcome models.
abstract: BACKGROUND
  Patients hospitalized for acute decompensated heart failure (ADHF) are at high risk for early mortality and rehospitalization. Risk stratification of ADHF using clinically available data on admission is increasingly important to integrate with clinical pathways. Our goal was to create a simple method of screening patients upon admission to identify those with increased risk of future adverse events.
  
  
  METHODS
  Using ASCEND-HF, a pragmatic clinical trial conducted in 398 sites globally, we developed and validated logistic regression risk models for (a) 30-day mortality/HF rehospitalization, (b) 30-day mortality/all-cause rehospitalization, (c) 30-day all-cause mortality, and (d) 180-day all-cause mortality. Fifty-one candidate variables were evaluated based on prior publications and clinical review. Final models were selected based on stepwise selection with entry and a staying criterion of P < .01. The 30-day mortality model was externally validated, and coefficients were converted to an additive risk score.
  
  
  RESULTS
  Among 7,141 patients, the median age was 67 years, 34% were female, and 80% had a left ventricular ejection fraction <40%. The models had between 5 and 12 risk factors with c-indices ranging from 0.68 to 0.75. A simplified score, including age, systolic blood pressure, sodium, blood urea nitrogen, and dyspnea at rest, discriminated 30-day mortality risk from 0.5% (score 0) to 53% (score 10).
  
  
  CONCLUSIONS
  Commonly available clinical variables provide simple risk stratification for clinical outcomes among patients with ADHF, and these models may be considered for integration into routine clinical care.
authors: Duke Clinical Research Institute, Durham, NC; Duke University School of Medicine, Durham, NC. Electronic address: prateeti.khazanie@duke.edu.
authors: Prateeti
authors: P
authors: Khazanie
authors: Duke Clinical Research Institute, Durham, NC.
authors: Gretchen M
authors: GM
authors: Heizer
authors: Duke Clinical Research Institute, Durham, NC.
authors: Vic
authors: V
authors: Hasselblad
authors: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors: Paul W
authors: PW
authors: Armstrong
authors: Duke Clinical Research Institute, Durham, NC; Duke University School of Medicine, Durham, NC.
authors: Robert M
authors: RM
authors: Califf
authors: Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
authors: Justin
authors: J
authors: Ezekowitz
authors: Stavenger University Hospital, University of Bergen, Bergen, Norway.
authors: Kenneth
authors: K
authors: Dickstein
authors: University of Washington Medical Center, Seattle, WA.
authors: Wayne C
authors: WC
authors: Levy
authors: British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
authors: John J V
authors: JJ
authors: McMurray
authors: Institute of Cardiology, University of Brescia, Brescia, Italy.
authors: Marco
authors: M
authors: Metra
authors: Cleveland Clinic Foundation, Cleveland, OH.
authors: W H Wilson
authors: WH
authors: Tang
authors: San Francisco Veterans Affairs Medical Center and University of California San Francisco, San Francisco, CA.
authors: John R
authors: JR
authors: Teerlink
authors: University of Groningen, Groningen, The Netherlands.
authors: Adriaan A
authors: AA
authors: Voors
authors: Duke Clinical Research Institute, Durham, NC; Duke University School of Medicine, Durham, NC.
authors: Christopher M
authors: CM
authors: O'Connor
authors: Duke Clinical Research Institute, Durham, NC; Duke University School of Medicine, Durham, NC.
authors: Adrian F
authors: AF
authors: Hernandez
authors: Cleveland Clinic Foundation, Cleveland, OH.
authors: Randall
authors: R
authors: Starling
mesh_terms: D000208:Acute Disease; D000368:Aged; D002423:Cause of Death / Q000639:trends; D004311:Double-Blind Method; D005060:Europe / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D007275:Injections, Intravenous; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000008:administration & dosage; D020097:Natriuretic Peptide, Brain / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D045283:Natriuretic Agents; D020097:Natriuretic Peptide, Brain