Key result
A 5-variable prediction model incorporating age, NYHA class, blood urea nitrogen, albumin, and vasopressor use demonstrated good discrimination for predicting 30-day irreversible worsening of cardiac function with a C-statistic of 0.866.
Why the study?
Irreversible worsening of cardiac function is associated with significant morbidity in ADHF, prompting the development of a simple clinical prediction model.
Observational (n=871)
No
Effect estimate: C-statistic 0.866 (95% CI 0.817–0.907)
A novel 5-variable prediction model and nomogram demonstrated good discrimination for estimating the risk of irreversible worsening of cardiac function in patients hospitalized with acute decompensated heart failure.
May support risk stratification in ADHF; hypothesis-generating and requires prospective validation before clinical use.
Background: Irreversible worsening of cardiac function is an adverse event associated with significant morbidity among patients with acute decompensated heart failure (ADHF). We aimed to develop a parsimonious model which is simple to use in clinical settings for the prediction of the risk of irreversible worsening of cardiac function. Methods: A total of 871 ADHF patients were enrolled in this study. Data for each patient were collected from the medical records. Irreversible worsening of cardiac function included cardiac death within 30-days of patient hospitalization, implantation of a left ventricular assistance device, or emergency heart transplantation. We performed LASSO regression for variable selection to derive a multivariable logistic regression model. Five candidate predictors were selected to derive the final prediction model. The prediction model was verified using C-statistics, calibration curve, and decision curve. Results: Irreversible worsening of cardiac function occurred in 7.8% of the patients. Advanced age, NYHA class, high blood urea nitrogen, hypoalbuminemia, and vasopressor use were its strongest predictors. The prediction model showed good discrimination C-statistic value, 0.866 (95% CI, 0.817–0.907), which indicated good identical calibration and clinical efficacy. Conclusion: In this study, we developed a prediction model and nomogram to estimate the risk of irreversible worsening of cardiac function among ADHF patients. The findings may provide a reference for clinical physicians for detection of irreversible worsening of cardiac function and enable its prompt management.
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Wang et al. (2021) conducted an observational in Acute Decompensated Heart Failure (ADHF) (n=871). Clinical risk predictors (age, NYHA class, blood urea nitrogen, albumin, vasopressor use) was evaluated on Irreversible worsening of cardiac function (cardiac death, LVAD implantation, or emergency heart transplantation within 30 days) (C-statistic 0.866, 95% CI 0.817–0.907). A 5-variable prediction model incorporating age, NYHA class, blood urea nitrogen, albumin, and vasopressor use demonstrated good discrimination for predicting 30-day irreversible worsening of cardiac function with a C-statistic of 0.866.
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