Prospective development and validation of a model to predict heart failure hospitalisation

Abstract

ObjectiveAcute heart failure syndrome (AHFS) is a major cause of hospitalisation and imparts a substantial burden on patients and healthcare systems. Tools to define risk of AHFS hospitalisation are lacking.MethodsA prospective cohort study (n=628) of patients with stable chronic heart failure (CHF) secondary to left ventricular systolic dysfunction was used to derive an AHFS prediction model which was then assessed in a prospectively recruited validation cohort (n=462).ResultsWithin the derivation cohort, 44 (7%) patients were hospitalised as a result of AHFS during 1 year of follow-up. Predictors of AHFS hospitalisation included furosemide equivalent dose, the presence of type 2 diabetes mellitus, AHFS hospitalisation within the previous year and pulmonary congestion on chest radiograph, all assessed at baseline. A multivariable model containing these four variables exhibited good calibration (Hosmer–Lemeshow p=0.38) and discrimination (C-statistic 0.77; 95% CI 0.71 to 0.84). Using a 2.5% risk cut-off for predicted AHFS, the model defined 38.5% of patients as low risk, with negative predictive value of 99.1%; this low risk cohort exhibited <1% excess all-cause mortality per annum when compared with contemporaneous actuarial data. Within the validation cohort, an identically applied model derived comparable performance parameters (C-statistic 0.81 (95% CI 0.74 to 0.87), Hosmer–Lemeshow p=0.15, negative predictive value 100%).ConclusionsA prospectively derived and validated model using simply obtained clinical data can identify patients with CHF at low risk of hospitalisation due to AHFS in the year following assessment. This may guide the design of future strategies allocating resources to the management of CHF.

Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry

“…In general established risk factors tracked the risk stratification gradient for HR and SBP except for diabetes and high BMI which were more frequent in the lower risk group which is different to previous observations [20][21][22] . High BMI is associated with a better prognosis in HF, and is also associated with diabetes and this may partially explain this observation 23 .…”

Impact of Diabetes Mellitus on Hospitalization for Heart Failure, Cardiovascular Events, and Death

“…23 Our data support prior studies that have also found an association between diabetes mellitus and increased risk of hospitalization for heart failure. 24 Despite these data, the association between diabetes mellitus and heart failure remains underrecognized by clinicians. 25 Nonetheless, in an era in which there is increasing emphasis on chronic disease management as a strategy to contain healthcare costs, these findings highlight the significance of diabetes mellitus and the need for therapies that improve outcomes in this population.…”

Vitamin D deficiency is an independent predictor of mortality in patients with chronic heart failure

“…As described in our previous publications [13,14], adult patients (> 18 years) were eligible to take part in the cohort study if they had stable symptoms and signs of CHF for 3 months, in addition to echocardiographic evidence of left ventricular systolic dysfunction (left ventricular (LV) ejection fraction (LVEF) ≤ 45%). Between June 2006 and July 2014, we recruited patients from the outpatient heart failure clinics of four hospitals in the north of England.…”