Inpatient Mortality Risk Scores and Postdischarge Events in Hospitalized Heart Failure Patients: A Community-Based Study.
Inpatient Mortality Risk Scores and Postdischarge Events in Hospitalized Heart Failure Patients: A Community-Based Study.
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DOI：
10.1161/circheartfailure.117.003926
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发表时间：
2017-07
期刊：
影响因子：
--
通讯作者：
Redfield MM
中科院分区：
文献类型：
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作者：
Win S;Hussain I;Hebl VB;Dunlay SM;Redfield MM
The Acute Decompensated Heart Failure National Registry (ADHERE) and Get with the Guidelines (GWTG) registries have developed simple heart failure (HF) in-hospital mortality risk scores. We hypothesized that HF scores predictive of in-hospital mortality would perform as well for early post-discharge mortality risk stratification. In this single center, community based, retrospective study of all consecutive primary HF hospitalizations (6203 hospitalizations in 3745 patients) from 2000 to 2013, the ADHERE and GWTG risk scores were calculated from admission data. There were 176 (3.0%) and 399 (6.7%), 869 (14.7%) and 1,272 (21.5%) deaths in-hospital and at 30, 90 and 180 days post-discharge respectively. The GWTG but not ADHERE risk score was well-calibrated for in-hospital mortality. Both the ADHERE (c-statistic 0.66 and 0.67, 0.64, 0.64) and GWTG (c-statistic 0.74 and 0.73, 0.71, 0.70) HF risk scores were similarly predictive of in-hospital and 30, 90 and 180-day post-discharge mortality. The ADHERE risk score identified 10% and the GWTG risk score identified 20% of hospitalizations where 180 day post-discharge mortality was 50%, a prognostic bench mark for hospice referral. In contrast, hospitalizations characterized as lowest risk by the ADHERE (57% of hospitalizations; 180 day mortality 16.2%) or GWTG score (20% of hospitalizations; 180 day mortality 8.0%) had substantially lower mortality (odds ratios high versus low risk of 5–8 (ADHERE) and 11–18 (GWTG) across time points, p<0.0001 for all). The simple ADHERE and GWTG scores stratify hospitalized HF patients for both in-patient and early post-discharge mortality risk, allowing comprehensive risk assessment on admission.
