Clinical Significance of Get With the Guidelines–Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization

Abstract

BackgroundThe Get With the Guidelines–Heart Failure (GWTG‐HF) risk score was developed using American Heart Association GWTG‐HF program data and predicts in‐hospital mortality in patients with acute heart failure (HF). We aimed to clarify the prognostic impacts of the GWTG‐HF risk score in patients with HF after discharge.Methods and ResultsWe examined the GWTG‐HF score in 1452 patients with HF, who were admitted to our hospital and discharged after treatment, by calculating 7 predetermined variables. We divided all subjects into 3 groups according to the GWTG‐HF risk score (low, moderate, and high score groups). The plasma B‐type natriuretic peptide level significantly increased with increasing GWTG‐HF risk score severity (median values of B‐type natriuretic peptide: 167.0 in low, 260.7 in moderate, and 418.2 pg/mL in high score groups). We followed up all subjects after discharge, and there were 347 (23.9%) all‐cause deaths and 407 (28.0%) cardiac events in follow‐up periods. A Kaplan‐Meier survival curve demonstrated that event rates of all‐cause death and cardiovascular events, including worsening HF and cardiac death, significantly increased with increasing GWTG‐HF risk score severity in all subjects, and also in 749 patients with HF with preserved ejection fraction (ejection fraction ≥50%) and 703 patients with HF with reduced ejection fraction (ejection fraction <50%) patients. The multivariable Cox proportional hazard regression analysis demonstrated that the GWTG‐HF risk score was one of the significant predictors of all‐cause mortality and cardiac events (all‐cause mortality: hazard ratio, 1.537, 95% confidence interval, 1.172–2.023; cardiac events: hazard ratio, 1.584, 95% confidence interval, 1.344–1.860, per 10‐point increase of GWTG‐HF score).ConclusionsThe GWTG‐HF risk score is a useful multivariable score model for several years after hospitalization in patients with HF in a Japanese population.

Sequential organ failure assessment score on admission predicts long‐term mortality in acute heart failure patients

“…To the best of our knowledge, there have been few studies demonstrating a long survival advantage associated with care at centres with better short‐term mortality rates for HF patients . The GWTG‐HF risk score was the only one to be related to short‐term and long‐term mortality . In the present results, the SOFA risk score on admission was useful for long‐term mortality prediction in HF patients, even without taking into account other potentially relevant variables, such as age, aetiology of HF, and LVEF.…”

“…In the recent study, the GWTG‐HF risk score indicated similar results to the SOFA score, predicting long‐term mortality in patients with HFrEF or HFpEF. Previous data showed that the GWTG‐HF risk score evaluates short‐term and long‐term mortality in patients with HFrEF or HFpEF . There are some differences in terms of pathophysiology and clinical characteristics between HFpEF and HFrEF .…”

“…Finally, a DCA, a method of calculating the net benefit in which the true positive value is subtracted from the false positive value, of the SOFA score and GWTG‐HF risk score was performed. The GWTG‐HF risk score is an established evaluation for predicting long‐term prognosis of patients with HF . New models combining the SOFA and GWTG‐HF risk scores were proven to be better than the GWTG‐HF risk score alone when assessed by NRI, IDI, and DCA.…”

“…On the other hand, the GWTG‐HF risk score was developed using a multivariable model that identified seven predictor variables. Using the sum of the points assigned for each predictor, the estimated probability of in‐hospital mortality for a particular patient can be determined, with the total point score ranging from 0 to 100 . In post hoc analysis, we performed postmortem analysis for acute HF patients with or without sepsis.…”

“…The American Heart Association Get With the Guidelines–Heart Failure (GWTG‐HF) risk score, APACHE‐III, and APACHE‐IV] can predict short‐term outcomes in HF patients . The GWTG‐HF risk score allows for 30‐day risk stratification for patients hospitalized with HF with reduced (HFrEF) and preserved ejection fraction (HFpEF), and it is associated with intermediate and long‐term mortality outcomes, along with median survival …”