Key result
High Heartmarker score links to steep drop in 1-year event-free survival, down to ~33%.
Why the study?
Heart failure biomarkers have prognostic value, but an objective classification system combining them for risk stratification of HF patients was needed.
Does the Heartmarker score improve risk stratification compared to NYHA classification in outpatients with heart failure?
Cohort (n=245)
No
Does the Heartmarker score improve risk stratification compared to NYHA classification in outpatients with heart failure?
Absolute Event Rate: 33% vs 97%
p-value: p=<0.01
The Heartmarker score, combining NT-proBNP, ST2, and GDF-15, provides an objective and reproducible model for risk stratification in heart failure outpatients that discriminates risk classes better than NYHA classification.
Background: Heart failure (HF) biomarkers have prognostic value. The aim of this study was to combine HF biomarkers into an objective classification system for risk stratification of patients with HF. Methods: HF biomarkers were analyzed in a population of HF outpatients and expressed relative to their cut-off values (N-terminal pro-B-type natriuretic peptide [NT-proBNP] >1,000 pg/mL, soluble suppression of tumorigenesis-2 [ST2] >35 ng/mL, growth differentiation factor-15 [GDF-15] >2,000 pg/mL, and fibroblast growth factor-23 [FGF-23] >95.4 pg/mL). Biomarkers that remained significant in multivariable analysis were combined to devise the Heartmarker score. The performance of the Heartmarker score was compared to the widely used New York Heart Association (NYHA) classification based on symptoms during ordinary activity. Results: HF biomarkers of 245 patients were analyzed, 45 (18%) of whom experienced the composite endpoint of HF hospitalization, appropriate implantable cardioverter-defibrillator shock, or death. HF biomarkers were elevated more often in patients that reached the composite endpoint than in patients that did not reach the endpoint. NT-proBNP, ST2, and GDF-15 were independent predictors of the composite endpoint and were thus combined as the Heartmarker score. The event-free survival and distance covered in 6 minutes of walking decreased with an increasing Heartmarker score. Compared with the NYHA classification, the Heartmarker score was better at discriminating between different risk classes and had a comparable relationship to functional capacity. Conclusions: The Heartmarker score is a reproducible and intuitive model for risk stratification of outpatients with HF, using routine biomarker measurements.
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Stam et al. (2022) conducted a cohort in Heart failure (n=245). Heartmarker score (combined NT-proBNP, ST2, and GDF-15) vs. Score of 0 (no elevated biomarkers) was evaluated on Composite of hospitalization for HF, appropriate ICD shock, or death (p=<0.01). The Heartmarker score effectively discriminated risk levels in heart failure outpatients, with 1-year event-free survival decreasing from 97% in patients with a score of 0 to 33% in those with a score of 3.
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