Transcript Document

A Validated Risk Score for In-hospital Mortality in Patients
with Heart Failure from the American Heart Association
Get With the Guidelines Program
Pamela N. Peterson, MD, MSPH; John S. Rumsfeld, MD, PhD; Li Liang,
PhD; Nancy M. Albert, RN, PhD; Adrian F. Hernandez, MD, MHS;
Eric D. Peterson, MD, MPH; Gregg C. Fonarow, MD;
Frederick A Masoudi, MD, MSPH
© 2010, American Heart Association. All rights reserved.
Background
HF is a common reason for hospitalization in the
United States and a tremendous economic burden.
Physicians often miss opportunities to improve the
quality of care for their patients hospitalized with HF
because they do not calibrate HF therapy to a
patient’s risk for adverse outcomes.
Peterson et al. Circulation: Cardiovascular Quality and Outcomes. 2010;3:25-32.
© 2010, American Heart Association. All rights reserved.
Introduction
Risk models may be useful in predicting in-hospital
mortality. Patients hospitalized with heart failure (HF)
provide a unique setting for the validation of such
prognostic information collection. The Get With The
Guidelines--HF (GWTG-HF) program’s validated risk score
has the potential to influence the quality of care provided to
patients hospitalized with HF by informing decision making
through routinely collected clinical data.
Peterson et al. Circulation: Cardiovascular Quality and Outcomes. 2010;3:25-32.
© 2010, American Heart Association. All rights reserved.
Objective
The purpose of this study was to derive and validate a
predictive model for in-hospital mortality using readily
available clinical data in patients with HF admitted to a
GWTG-HF hospital.
Peterson et al. Circulation: Cardiovascular Quality and Outcomes. 2010;3:25-32
© 2010, American Heart Association. All rights reserved.
Methods
• Between January 2005 and June 2007, data were
collected from a cohort of 39,783 patients admitted
to 198 GWTG-HF participating hospitals.
• Potential predictor variables included demographics, co-morbidities, admission laboratory
information, vital signs at presentation, and LV
systolic dysfunction of ≤ 40%.
Peterson et al. Circulation: Cardiovascular Quality and Outcomes. 2010;3:25-32.
© 2010, American Heart Association. All rights reserved.
Results
•
In-hospital death occurred in 1139 (2.86%) patients. Those who died
were more likely to have a prior HF diagnosis and an LVEF < 40%, atrial
fibrillation, CAD, COPD, anemia and renal insufficiency, higher heart
rates, serum creatinine and BUN levels and lower blood pressure,
serum sodium and hemoglobin levels on admission, but less likely to
have hypertension, hyperlipidemia, or diabetes.
•
Age, systolic blood pressure, BUN level, serum sodium, and heart rate
on admission, non--Black race and the presence of COPD were
independent predictors of in-hospital death.
•
No significant interactions between left ventricular systolic function
and coexisting illnesses were present, indicating that the impact of
individual risk factors on outcome was consistent regardless of left
ventricular function.
Peterson et al. Circulation: Cardiovascular Quality and Outcomes. 2010;3:25-32
© 2010, American Heart Association. All rights reserved.
Conclusions
Age, systolic blood pressure, and BUN level are the
admission variables most predictive of in-hospital
mortality, with admission heart rate, serum sodium,
presence of COPD, and non--Black race contributing
modestly. The validated GWTG-HF risk score uses
routinely collected data to predict the risk of in-hospital
mortality for patients hospitalized with HF. Application of
the risk score derived from routine clinical factors
collected at the time of admission could influence the
quality of care provided to patients hospitalized with HF
by informing clinical decision making.
Peterson et al. Circulation: Cardiovascular Quality and Outcomes. 2010;3:25-32
© 2010, American Heart Association. All rights reserved.