<p>The prognosis of patients hospitalized with a first episode of heart failure, validation of two scores: PREDICE and AHEAD</p>

Abstract

Purpose Heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this study was to validate the two available clinical prediction rules for mortality at one year in patients with primo-hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients hospitalized for a first episode of the disease. Patients and methods A prospective multicenter cohort study, which included 180 patients hospitalized with “de novo” HF was conducted to validate the PREDICE score. Calibration and discrimination measurements were calculated for the PREDICE model and the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score (using both the development and the validation cohort of the PREDICE). Results For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence interval [CI]: 0.57–0.79) and the calibration slope 0.65 (95% CI: 0.21–1.20). For the PREDICE score AUC was 0.59 (95% CI: 0.47–0.71) and slope 0.42 (95% CI: −0.20–1.17). For the AHEAD score the AUC was 0.68 (95% CI: 0.62–0.73) and slope 1.38 (95% CI: 0.62–0.73) when used the development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49–0.67), and slope 0.68 (95% CI: −0.06 to 1.47) when used its validation cohort. Conclusion The present study shows that the two risk scores available for patients with primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized patients with new-onset HF has been modified over time. The study underscores the need to validate the prognostic models before clinical implementation.

The different risk of new‐onset, chronic, worsening, and advanced heart failure: A systematic review and meta‐regression analysis

“…Following the title and abstract screening process, 292 studies were deemed eligible for full‐text screening. Ultimately, during the final phase of full‐text screening, 65 studies (comprising 88 cohorts) met the inclusion criteria and were included in the subsequent meta‐analysis 10–74 . One additional study was identified through a manual cross‐reference of the included studies, bringing the total to 66 studies 75 (online supplementary Figure ).…”

Five‐year mortality of heart failure with preserved, mildly reduced, and reduced ejection fraction in a 4880 Chinese cohort

“…The medical treatment has an obvious therapeutic effect on HFrEF and HFmrEF but has a limited effect on HFpEF. Although the prevalence of HFpEF has increased significantly in recent years, 36 the treatment for HFpEF remains a challenge for clinicians. It is also necessary to develop multidisciplinary interventions for HF patients to provide appropriate treatment for this population to improve their quality of life.…”

Determinants of survival in patients with chronic heart failure: a population‐based study in Reggio Emilia, Italy

“…Diagnostic and therapeutic improvements in recent years led to increased survival of patients with HF, increasing the pool of CHF patients and consequently increasing recurrent hospitalizations. Various prognostic models of re‐hospitalization and death from HF in ‘acute’ patients have been identified 2,3 . However, these prognostic factors are not always applicable to more stable ‘chronic’ HF patients diagnosed and cared for in community settings.…”

“…Various prognostic models of re‐hospitalization and death from HF in ‘acute’ patients have been identified. 2 , 3 However, these prognostic factors are not always applicable to more stable ‘chronic’ HF patients diagnosed and cared for in community settings.…”