EAARN score, a predictive score for mortality in patients receiving cardiac resynchronization therapy based on pre‐implantation risk factors

Abstract

AimsThe beneficial effects of CRT in patients with advanced heart failure, wide QRS, and low LVEF have been clearly established. Nevertheless, mortality remains high in some patients. The aims of our study were to identify the predictors of mortality in patients treated with CRT and to design a risk score for mortality.Methods and resultsA cohort of 608 consecutive patients treated with CRT from 2000 to 2011 in our centre was prospectively analysed. Baseline clinical and echocardiography variables were analysed and mortality data were collected. During a mean follow-up of 36.2 ± 29.2 months, 174 patients died: 123/174 (71%) due to cardiovascular causes, 25/174 (14%) non-cardiac causes, and 26/174 (15%) unknown aetiology. In a multivariate analysis the predictors of mortality were NYHA class IV [hazard ratio (HR) 2.54, 95% confidence interval (CI) 1.7–3.7, P < 0.001], glomerular filtration rate (GFR) <60 mL/min/1.73 m2 (HR 1.61, 95% CI 1.14–2.30, P = 0.008), AF (HR 1.67, 95% CI 1.19–2.3, P = 0.01), age ≥70 years (HR 1.44, (95% CI 1.04–2.00, P = 0.02), and LVEF <22% (HR 1.83, 95% CI 1.33–2.52, P ≤ 0.001). The EAARN score (EF, Age, AF, Renal dysfunction, NYHA class IV) summarizes the predictors. Each additional predictor increased the mortality: one predictor, HR 3.28 (95% CI 1.37–7.8, P = 0.008); two, HR 5.23 (95% CI 2.24–12.10, P < 0.001); three, HR 9.63 (95% CI 4.1–22.60, P < 0.001); and four or more, HR 14.38 (95% CI 5.8–35.65, P < 0.001).ConclusionThe predictors of mortality have a significant add-on predictive effect on mortality. The EAARN score could be useful to stratify the prognosis of CRT patients.

Cardiac Resynchronization Therapy in Advanced Heart Failure: Predictors of Response and Optimization of Therapy

“…Some studies [5] do not show differences in mortality in older and younger patients. Other works [6] show that a greater age is a risk factor for higher mortality, together with other data (New York Heart Association functional class IV, impaired renal function, atrial fibrillation, and left ventricular ejection fraction <22%). With this doubt, the implantation of these devices could be considered in patients with advanced functional stages and older age.…”

The VALID‐CRT risk score reliably predicts response and outcome of cardiac resynchronization therapy in a real‐world population

“…Three other simple scores proved to readily predict survival after CRT. The EAARN score, a simple score based on LVEF, age, atrial fibrillation, renal dysfunction, and NYHA class IV had a significant add‐on predictive effect with regard to mortality, but has not been externally validated . The HF‐CRT score, which combined clinical and readily available biomarker data, stratified CRT patients for HF progression and death .…”

Predictors of mortality, LVAD implant, or heart transplant in primary prevention cardiac resynchronization therapy recipients: The HF-CRT score

“…A recent paper identified NYHA functional class IV, eGFR <60 ml/min/1.73m 2 , age ≥70 years, atrial fibrillation and ejection fraction <22% to be associated with mortality over a mean follow-up of 36.2 ± 29.2 months (8). Another study looking at predictors of long-term mortality in CRT found larger left ventricular end-systolic volume, less distance covered in the 6 min walking test, poor renal function, more severe heart failure, male gender, and presence of atrial fibrillation, no posterolateral left ventricular (LV) lead, and no LV dyssynchrony to be associated with poor prognosis after CRT (9).…”

“…These prior risk modeling studies have been limited by highly selected patient groups and the absence of serum biomarkers now known to play an integral role in HF progression (8,9). We sought to identify predictors of mortality and early need for advanced circulatory support interventions among the cohort of primary prevention CRT-defibrillator (CRT-D) recipients in the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD).…”