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Predicting Risk in Patients Hospitalized for Acute Decompensated Heart Failure and Preserved Ejection Fraction: The Atherosclerosis Risk in Communities Study Heart Failure Community Surveillance.
- Source :
- Circulation: Heart Failure; Dec2017, Vol. 10 Issue 12, p1-10, 10p, 1 Diagram, 4 Charts, 1 Graph
- Publication Year :
- 2017
-
Abstract
- BACKGROUND: Risk-prediction models specifically for hospitalized heart failure with preserved ejection fraction are lacking. METHODS AND RESULTS: We analyzed data from the ARIC (Atherosclerosis Risk in Communities) Study Heart Failure Community Surveillance to create and validate a risk score predicting mortality in patients ≥55 years of age admitted with acute decompensated heart failure with preserved ejection fraction (ejection fraction ≥50%). A modified version of the risk-prediction model for acute heart failure developed from patients in the EFFECT (Enhanced Feedback for Effective Cardiac Treatment) study was used as a composite predictor of 28- day and 1-year mortalities and evaluated together with other potential predictors in a stepwise logistic regression. The derivation sample consisted of 1852 hospitalizations from 2005 to 2011 (mean age, 77 years; 65% women; 74% white). Risk scores were created from the identified predictors and validated in hospitalizations from 2012 to 2013 (n=821). Mortality in the derivation and validation sample was 11% and 8% at 28 days and 34% and 31% at 1 year. The modified EFFECT score, including age, systolic blood pressure, blood urea nitrogen, sodium, cerebrovascular disease, chronic obstructive pulmonary disease, and hemoglobin, was a powerful predictor of mortality. Another important predictor for both 28-day and 1-year mortalities was hypoxia. The risk scores were well calibrated and had good discrimination in the derivation sample (area under the curve: 0.76 for 28-day and 0.72 for 1-year mortalities) and validation sample (area under the curve: 0.73 and 0.71, respectively). CONCLUSIONS: Mortality after acute decompensation in patients with heart failure with preserved ejection fraction is high, with one third of patients dying within a year. A prediction tool may allow for greater discrimination of the highest risk patients. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 19413289
- Volume :
- 10
- Issue :
- 12
- Database :
- Supplemental Index
- Journal :
- Circulation: Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 126933006
- Full Text :
- https://doi.org/10.1161/CIRCHEARTFAILURE.117.003992