In ED patients hospitalized with heart failure, the GWTG-HF score showed higher discrimination for 30-day mortality than the ADHERE CART score (AUC 0.75 vs 0.64; difference 0.10; P < .001).
Cohort (n=4,812)
Does the GWTG-HF risk score improve prediction of 30-day mortality compared to ADHERE CART in emergency department patients hospitalized with heart failure?
The GWTG-HF risk score provides superior discrimination for 30-day mortality compared to ADHERE CART in ED patients hospitalized with heart failure, though neither score reliably predicts ICU admission or AKI.
Effect estimate: AUC difference 0.10
Absolute Event Rate: 0.75% vs 0.64%
p-value: p=< .001
Early risk stratification may support emergency department (ED) decision-making for patients hospitalized with heart failure (HF), yet commonly used tools may perform differently across clinically relevant outcomes. We conducted a retrospective observational cohort study using MIMIC-IV (v3.1) linked to MIMIC-IV-ED (2011–2019). Adult ED encounters with HF International Classification of Diseases-9/10 codes from the ED diagnosis table that were linkable to an inpatient admission were included. The primary analytic cohort was restricted to complete-case encounters with sufficient data to compute both Acute Decompensated Heart Failure National Registry (ADHERE) CART and Get With The Guidelines–Heart Failure (GWTG-HF). The primary outcome was 30-day all-cause mortality; secondary outcomes were intensive care unit (ICU) admission within 24 hours after ED disposition, any ICU admission, acute kidney injury (AKI; Kidney Disease Improving Global Outcomes creatinine criteria), and hospital/ICU length of stay. Associations were evaluated using univariable logistic regression. Discrimination was assessed by area under the receiver operating characteristic curve (bootstrap 95% confidence intervals CIs) and compared using DeLong test. Calibration was assessed with patient-level 10-fold cross-validated calibration intercept/slope and calibration curves. Among 5508 eligible encounters, 4812 had complete data for both scores and constituted the analytic cohort. Thirty-day mortality occurred in 317/4812 (6.6%). ICU admission within 24 hours after ED disposition occurred in 822/4812 (17.1%), any ICU admission in 1098/4812 (22.8%), and AKI in 1373/4810 (28.5%). GWTG-HF was associated with higher 30-day mortality (odds ratio 2.3 per 10 points, 95% CI 2.1–2.6); ADHERE CART also showed higher odds across strata (group 4 vs 1 odds ratio 5.2, 95% CI 3.1–8.8). Mortality discrimination was higher for GWTG-HF than ADHERE (area under the receiver operating characteristic curve 0.75 vs 0.64; difference 0.10; P < .001), with near-ideal calibration for both. In ED patients hospitalized with HF, GWTG-HF more reliably stratified 30-day mortality risk than ADHERE CART, while both scores showed limited utility for ICU utilization and AKI, supporting outcome-specific and dynamic risk assessment.
Aykut et al. (Fri,) conducted a cohort in Heart failure (n=4,812). GWTG-HF score vs. ADHERE CART score was evaluated on 30-day all-cause mortality discrimination (AUC) (AUC difference 0.10, p=< .001). In ED patients hospitalized with heart failure, the GWTG-HF score showed higher discrimination for 30-day mortality than the ADHERE CART score (AUC 0.75 vs 0.64; difference 0.10; P < .001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: