Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores
Introduction The Intermountain Risk Score (IMRS) was developed and validated to predict short-term and long-term mortality in hospitalised patients using demographics and commonly available laboratory data. In this study, we sought to determine whether the IMRS also predicts all-cause mortality in p...
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| Format: | Article |
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BMJ Publishing Group
2019-05-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/6/1/e000961.full |
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| author | Kirk U Knowlton Benjamin D Horne Paul A Heidenreich Gomathi Krishnan Kalyani Anil Boralkar Yukari Kobayashi Kegan J Moneghetti Vedant S Pargaonkar Mirela Tuzovic Matthew T Wheeler Dipanjan Banerjee Tatiana Kuznetsova Francois Haddad |
| author_facet | Kirk U Knowlton Benjamin D Horne Paul A Heidenreich Gomathi Krishnan Kalyani Anil Boralkar Yukari Kobayashi Kegan J Moneghetti Vedant S Pargaonkar Mirela Tuzovic Matthew T Wheeler Dipanjan Banerjee Tatiana Kuznetsova Francois Haddad |
| author_sort | Kirk U Knowlton |
| collection | DOAJ |
| description | Introduction The Intermountain Risk Score (IMRS) was developed and validated to predict short-term and long-term mortality in hospitalised patients using demographics and commonly available laboratory data. In this study, we sought to determine whether the IMRS also predicts all-cause mortality in patients hospitalised with heart failure with preserved ejection fraction (HFpEF) and whether it is complementary to the Get with the Guidelines Heart Failure (GWTG-HF) risk score or N-terminal pro-B-type natriuretic peptide (NT-proBNP).Methods and results We used the Stanford Translational Research Integrated Database Environment to identify 3847 adult patients with a diagnosis of HFpEF between January 1998 and December 2016. Of these, 580 were hospitalised with a primary diagnosis of acute HFpEF. Mean age was 76±16 years, the majority being female (58%), with a high prevalence of diabetes mellitus (36%) and a history of coronary artery disease (60%). Over a median follow-up of 2.0 years, 140 (24%) patients died. On multivariable analysis, the IMRS and GWTG-HF risk score were independently associated with all-cause mortality (standardised HRs IMRS (1.55 (95% CI 1.27 to 1.93)); GWTG-HF (1.60 (95% CI 1.27 to 2.01))). Combining the two scores, improved the net reclassification over GWTG-HF alone by 36.2%. In patients with available NT-proBNP (n=341), NT-proBNP improved the net reclassification of each score by 46.2% (IMRS) and 36.3% (GWTG-HF).Conclusion IMRS and GWTG-HF risk scores, along with NT-proBNP, play a complementary role in predicting outcome in patients hospitalised with HFpEF. |
| format | Article |
| id | doaj-art-c3b4fefe37eb4b3aa5df76bb5fc34e75 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2019-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-c3b4fefe37eb4b3aa5df76bb5fc34e752024-11-12T13:30:08ZengBMJ Publishing GroupOpen Heart2053-36242019-05-016110.1136/openhrt-2018-000961Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scoresKirk U Knowlton0Benjamin D Horne1Paul A Heidenreich2Gomathi Krishnan3Kalyani Anil Boralkar4Yukari Kobayashi5Kegan J Moneghetti6Vedant S Pargaonkar7Mirela Tuzovic8Matthew T Wheeler9Dipanjan Banerjee10Tatiana Kuznetsova11Francois Haddad125 Department of Medicine, Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA1 Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USACardiovascular Institute, Stanford University School of Medicine, Stanford, California, USACardiovascular Institute, Stanford University School of Medicine, Stanford, California, USACardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA1 Department of Immunotherapeutics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, JapanDepartment of Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USACardiovascular Institute, Stanford University School of Medicine, Stanford, California, USACardiovascular Institute, Stanford University School of Medicine, Stanford, California, USADepartment of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USACardiovascular Institute, Stanford University School of Medicine, Stanford, California, USAResearch Unit Hypertension and Cardiovascular Epidemiology KU Leuven, Department of Cardiovascular Sciences, University of Leuven, Leuven, BelgiumDepartment of Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, California, USAIntroduction The Intermountain Risk Score (IMRS) was developed and validated to predict short-term and long-term mortality in hospitalised patients using demographics and commonly available laboratory data. In this study, we sought to determine whether the IMRS also predicts all-cause mortality in patients hospitalised with heart failure with preserved ejection fraction (HFpEF) and whether it is complementary to the Get with the Guidelines Heart Failure (GWTG-HF) risk score or N-terminal pro-B-type natriuretic peptide (NT-proBNP).Methods and results We used the Stanford Translational Research Integrated Database Environment to identify 3847 adult patients with a diagnosis of HFpEF between January 1998 and December 2016. Of these, 580 were hospitalised with a primary diagnosis of acute HFpEF. Mean age was 76±16 years, the majority being female (58%), with a high prevalence of diabetes mellitus (36%) and a history of coronary artery disease (60%). Over a median follow-up of 2.0 years, 140 (24%) patients died. On multivariable analysis, the IMRS and GWTG-HF risk score were independently associated with all-cause mortality (standardised HRs IMRS (1.55 (95% CI 1.27 to 1.93)); GWTG-HF (1.60 (95% CI 1.27 to 2.01))). Combining the two scores, improved the net reclassification over GWTG-HF alone by 36.2%. In patients with available NT-proBNP (n=341), NT-proBNP improved the net reclassification of each score by 46.2% (IMRS) and 36.3% (GWTG-HF).Conclusion IMRS and GWTG-HF risk scores, along with NT-proBNP, play a complementary role in predicting outcome in patients hospitalised with HFpEF.https://openheart.bmj.com/content/6/1/e000961.full |
| spellingShingle | Kirk U Knowlton Benjamin D Horne Paul A Heidenreich Gomathi Krishnan Kalyani Anil Boralkar Yukari Kobayashi Kegan J Moneghetti Vedant S Pargaonkar Mirela Tuzovic Matthew T Wheeler Dipanjan Banerjee Tatiana Kuznetsova Francois Haddad Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores Open Heart |
| title | Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores |
| title_full | Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores |
| title_fullStr | Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores |
| title_full_unstemmed | Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores |
| title_short | Improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores |
| title_sort | improving risk stratification in heart failure with preserved ejection fraction by combining two validated risk scores |
| url | https://openheart.bmj.com/content/6/1/e000961.full |
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