Mortality Risk Prediction Dynamics After Heart Failure Treatment Optimization: Repeat Risk Assessment Using Online Risk Calculators

Frontiers in Cardiovascular Medicine

article

Giosafat Spitaleri¹  Germán Cediel¹  María Ruiz-Cueto¹  Elena Cañedo¹  Evelyn Santiago-Vacas¹  Mar Domingo¹  David Buchaca⁴  Isaac Subirana⁵  Javier Santesmases¹  Rafael de la Espriella⁷  Julio Nuñez²  Josep Lupón¹  Antoni Bayes-Genis¹  Pau Codina¹  Elisabet Zamora¹  Wayne C. Levy⁹  Elena Revuelta-López²  Andrea Borrellas¹ 

[1] Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol;Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares ,(CIBERCV), Instituto de Salud Carlos III;Department of Medicine, Universitat de Barcelona;Barcelona Supercomputing Center;Hospital del Mar Medical Research Institute;Department of Medicine, Universitat Autonoma de Barcelona;Cardiology Department, Hospital Clínico Universitario, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana ,(INCLIVA);Department of Medicine, Universidad de Valencia;UW Medicine Heart Institute, University of Washington;Heart Failure and Cardiac Regeneration ,(ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol

关键词: heart failure;    mortality;    risk models;    risk prediction;    prognosis;   

DOI  :  10.3389/fcvm.2022.836451

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Objectives Heart failure (HF) management has significantly improved over the past two decades, leading to better survival. This study aimed to assess changes in predicted mortality risk after 12 months of management in a multidisciplinary HF clinic. Materials and Methods Out of 1,032 consecutive HF outpatients admitted from March-2012 to November-2018, 357 completed the 12-months follow-up and had N-terminal pro-B-type natriuretic peptide (NTproBNP), high sensitivity troponin T (hs-TnT), and interleukin-1 receptor-like-1 (known as ST2) measurements available both at baseline and follow-up. Three contemporary risk scores were used: MAGGIC-HF, Seattle HF Model (SHFM), and the Barcelona Bio-HF (BCN Bio-HF) calculator, which incorporates the three above mentioned biomarkers. The predicted risk of all-cause death at 1 and 3 years was calculated at baseline and re-evaluated after 12 months. Results A significant decline in predicted 1-and 3-year mortality risk was observed at 12 months: MAGGIC ~16%, SHFM ~22% and BCN Bio-HF ~15%. In the HF with reduced ejection fraction (HFrEF) subgroup guideline-directed medical therapy led to a complete normalization of left ventricular ejection fraction (≥50%) in almost a third of the patients and to a partial normalization (41–49%) in 30% of them. Repeated risk assessment after 12 months with SHFM and BCN Bio-HF provided adequate discrimination for all-cause 3-year mortality (C-Index: MAGGIC-HF 0.762, SHFM 0.781 and BCN Bio-HF 0.791). Conclusion Mortality risk declines in patients with HF managed for 12 months in a multidisciplinary HF clinic. Repeating the mortality risk assessment after optimizing the HF treatment is recommended, particularly in the HFrEF subgroup.

【 授权许可】

CC BY