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January 30, 2019Circulation JournalOpen Access

Comparison of Mortality Prediction Models on Long-Term Mortality in Hospitalized Patients With Acute Heart Failure ― The Importance of Accounting for Nutritional Status ―

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Why the study?

Published mortality prediction models for acute heart failure predominantly predict short-term mortality up to 90 days, leaving their prognostic performance for long-term mortality unclear.

Does the inclusion of nutritional markers improve the predictive performance of mortality prediction models for long-term mortality in patients with acute heart failure?

Population

609 AHF patients in a prospective registry

Comparison

8 systematically identified short-term mortality prediction models

Design

Prospective registry analysis

Key result

The PROTECT 7-day model demonstrated the highest predictive performance for long-term mortality (c-index ≥0.73) among 8 published mortality prediction models in patients with acute heart failure.

Authors

HNHiroki NakanoKOKazunori OmoteTNToshiyuki Nagai

Discussion

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Member takes

Overview

Nutritional markers may enhance AHF mortality prediction; leaves open whether adding them improves other models in prospective cohorts.

Study Design

Type

Observational (n=609)

Multicenter

No

Structured PICO

Does the inclusion of nutritional markers improve the predictive performance of mortality prediction models for long-term mortality in patients with acute heart failure?

P
Population
609 patients aged >20 years hospitalized for acute heart failure at a single center in Japan, followed for up to 360 days to compare the predictive ability of 8 mortality prediction models.
E
Exposure
Application of 8 published mortality prediction models (PROTECT 7-day, GWTG-HF, OPTIMIZE-HF in-hospital, ADHERE, EFFECT 30-day, ASCEND-HF 30-day, OPTIME-CHF 60-day, OPTIMIZE-HF 90-day) and addition of nutritional markers (serum albumin, total cholesterol, CONUT score) to these models.
C
Comparator
Comparison among the 8 models, and comparison of the original models versus models supplemented with nutritional markers.
O
Outcome
Predictive performance (Harrell's c-index) for long-term mortality at 180 and 360 days.hard clinical

The PROTECT 7-day model best predicts long-term mortality in acute heart failure, largely due to its inclusion of nutritional markers like serum albumin and total cholesterol, which improve the predictive ability of other models when added.

Limitations

  • Single-center registry with a small sample size and number of events, limiting generalizability and statistical power.
  • Could not confirm the validity of findings in AHF patients without prior HF hospitalization (de novo AHF) due to limited sample size.
  • Evaluation of the additional value of nutritional parameters was limited to 180 and 360 days due to the small number of events.
  • Single-center registry with a small sample size and number of events
  • Could not confirm the validity of findings in AHF patients without prior HF hospitalization due to limited sample size
  • Could evaluate the additional value of nutritional parameters only at 180 and 360 days because of the limited number of events

Cite This Study

Nakano et al. (2019) conducted an observational in Acute Heart Failure (n=609). PROTECT 7-day mortality prediction model vs. Other published mortality prediction models (e.g., GWTG-HF, ADHERE) was evaluated on Predictive performance (c-index) for long-term mortality at 180 and 360 days. The PROTECT 7-day model demonstrated the highest predictive performance for long-term mortality (c-index ≥0.73) among 8 published mortality prediction models in patients with acute heart failure.

synapsesocial.com/papers/6a7c8dbf668c3162adc890efhttps://doi.org/10.1253/circj.cj-18-1243
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Validation and Comparison of Seven Mortality Prediction Models for Hospitalized Patients With Acute Decompensated Heart Failure2016 · 99 citations
  2. 2Risk Classification for Long-Term Mortality Among Patients with Acute Heart Failure: China PEACE 4YMortality2025
  3. 3Combined Prognostic Value of the PROFUND Index and Serum Albumin for One-Year Mortality in Elderly Patients with Acute Heart Failure2026
  4. 4Predicting the risk of 1-year mortality among patients hospitalized for acute heart failure in China2024
  5. 5Comparison of objective nutritional indexes for the prediction of in-hospital mortality among elderly patients with acute heart failure2020 · 19 citations