Heart failure
A Novel Prognostic Index to Determine the Impact of Cardiac Conditions and Co-Morbidities on One-Year Outcome in Patients With Heart Failure

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Prognostic stratification is relevant in clinical decision making in heart failure (HF). Predictors identified during hospitalization or in clinical trials may be unrepresentative of HF in the community. The aim of this study was to derive and validate, in different clinical settings, a risk stratification model for the prediction of stable HF outcomes. The study included 807 patients, 350 enrolled at discharge from the hospital (44%), 309 in the outpatient clinic (38%), and 148 in the home-care setting (18%). There were 292 patients in the derivation cohort and 515 in the validation cohort. A multivariate logistic analysis was performed to obtain the CardioVascular Medicine Heart Failure (CVM-HF) index. One-year mortality was 20.8% in the derivation cohort and 20.7% in the validation cohort. The CVM-HF index included cardiac conditions and co-morbidities and stratified the 1-year mortality risk as low (death rate 4%), average (32%), high (63%), and very high (96%). The area under the curve of the receiver-operating characteristic curve was 0.844 (95% confidence interval [CI] 0.779 to 0.89) for the derivation cohort and 0.812 (95% CI 0.76 to 0.86) for the validation cohort. Model performance was equally good in the 3 different HF settings. In a subgroup of 409 patients, the CVM-HF index (area under the curve 0.821, 95% CI 0.79 to 0.89) outperformed the most-used prognostic models (the Charlson index and the Heart Failure Risk Scoring System). In conclusion, the CVM-HF index, a novel prognostic model that is easy to derive and applicable to unselected patients, may represent a valuable tool for the prognostication of stable HF outcomes.

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Study population

The study population consisted of 807 patients, of whom 292 (the derivation cohort) were consecutively enrolled from January 1, 2003, to April 30, 2003, in 3 different clinical settings and used to develop the CardioVascular Medicine Heart Failure (CVM-HF) index: 139 (48%) at discharge from the hospital, 111 (38%) in the outpatient clinic, and 42 (14%) in the home-care setting. The data from the remaining 515 patients (the validation cohort), enrolled from May to December 2003, were used to

Results

Table 1, Table 2 list the set of candidate predictors of survival at 1 year considered at the beginning of the analysis, subdivided into demographic and clinical predictors. The mean age at recruitment was greater in women than in men (76 ± 14 vs 67 ± 13 years, p <0.0001). Quantitative assessment of systolic ventricular function was available in 252 patients (86%, mean left ventricular ejection fraction 38 ± 13%) of the derivation cohort and in 409 patients (79%, mean left ventricular ejection

Discussion

We developed a model to evaluate the 1-year risk for all-cause mortality from the combination of demographic data, routine biochemistry, co-morbidities, and a few cardiovascular variables and tested it in different clinical settings and in all stages of HF. Our index performed well in the derivation and validation cohorts, with AUC values superior to those previously reported1, 14: score percentiles clearly discriminated prognosis, and the curves started to diverge after the first month of

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