Triage after hospitalization with advanced heart failure: the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) risk model and discharge score.
Triage after hospitalization with advanced heart failure: the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) risk model and discharge score.
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DOI：
10.1016/j.jacc.2009.08.083
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发表时间：
2010-03-02
影响因子：
24
通讯作者：
Stevenson, Lynne W.
中科院分区：
文献类型：
--
作者：
O'Connor, Christopher M.;Hasselblad, Vic;Mehta, Rajendra H.;Tasissa, Gudaye;Califf, Robert M.;Fiuzat, Mona;Rogers, Joseph G.;Leier, Carl V.;Stevenson, Lynne W.
在出院时识别高危心力衰竭（HF）患者可以更有效地分诊管理策略。出现时的心衰严重程度可以预测预后，但由于干预措施导致的临床状态改变对预后的重要性却没有得到很好的描述。使用ESCAPE的数据创建住院期间获得的变量的预测模型，并通过bootstrapping方法进行内部验证。将模型系数转换为可加性风险评分。此外，来自FIRST （Flolan国际随机生存试验）的数据用于外部验证该模型。出院时资料完整的患者（n=423） 6个月死亡率和再住院死亡率分别为18.7%和64%。死亡的出院危险因素包括BNP，每两倍（危险比[HR]: 1.42, 95%可信区间[CI]: 1.15-1.75），住院期间心肺复苏或机械通气（危险比：2.54,95% CI: 1.12-5.78），血尿素氮，每20 u增加（危险比：1.22,95% CI: 0.96-1.55），血清钠，每单位增加（危险比：0.93,95% CI: 0.87-0.99），年龄bbb70（危险比：1.05,95% CI: 0.51-2.17），每日循环利尿剂，速尿当量>240 mg（危险比：1.49,95% CI: 1.49）：0.68-3.26)，缺乏β受体阻滞剂（HR: 1.28, 95% CI: 0.68-2.41），以及每增加100英尺步行6分钟（HR: 0.955, 95% CI: 0.99-1.00； c指数0.76）。简化出院评分区分死亡率风险从5%（评分=0）到94%（评分=8）。Bootstrap验证表明模型具有良好的内部验证性（c指数0.78,95% CI: 0.68-0.83）。ESCAPE出院风险模型和评分改进了晚期失代偿性收缩期心衰住院治疗后的风险评估，使临床医生能够集中监测和分诊，对这一高危人群进行早期救生干预。
Identifying high-risk heart failure (HF) patients at hospital discharge may allow more effective triage to management strategies. HF severity at presentation predicts outcomes, but the prognostic importance of clinical status changes due to interventions is less well described. Predictive models using variables obtained during hospitalization were created using data from ESCAPE and internally validated by bootstrapping method. Model coefficients were converted to an additive risk score. Additionally, data from the FIRST (Flolan International Randomized Survival Trial) was used to externally validate this model. Patients discharged with complete data (n=423) had 6-month mortality and death or rehospitalization rates of 18.7% and 64%. Discharge risk factors for mortality included BNP, per doubling (Hazard Ration [HR]: 1.42, 95% confidence interval [CI]: 1.15–1.75), cardiopulmonary resuscitation or mechanical ventilation during hospitalization (HR: 2.54, 95% CI: 1.12–5.78), blood urea nitrogen, per 20-U increase) (HR: 1.22, 95% CI: 0.96–1.55), serum sodium, per unit increase (HR: 0.93, 95% CI: 0.87–0.99), age >70 (HR: 1.05, 95% CI: 0.51–2.17), daily loop diuretic, furosemide equivalents >240 mg (HR: 1.49, 95% CI: 0.68–3.26), lack of beta-blocker (HR: 1.28, 95% CI: 0.68–2.41), and 6-minute walk, per 100 feet increase (HR: 0.955, 95% CI: 0.99–1.00; c index 0.76. A simplified discharge score discriminated mortality risk from 5% (score=0) to 94% (score =8). Bootstrap validation demonstrated good internal validation of the model (c index 0.78, 95% CI: 0.68–0.83). The ESCAPE discharge risk model and score refine risk assessment after inhospital therapy for advanced decompensated systolic HF, allowing clinicians to focus surveillance and triage for early life-saving interventions in this high-risk population.
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