Key result
Simple risk score stratifies mortality in hospitalized HF patients, revealing a ~5-year median survival gap.
Why the study?
Current models used to stratify patients with heart failure are complex, difficult to use, and limited by short follow-up and patient selection.
Cohort (n=701)
Effect estimate: HR between 1.5 and 2.0
A simple 6-point risk score based on clinical variables at admission can effectively predict long-term mortality in patients hospitalized for heart failure.
Simple six-variable score stratifies long-term HF mortality; leaves open prospective validation before clinical adoption.
BACKGROUND AND OBJECTIVES: Current models used to stratify patients with heart failure are complex, difficult to use, and limited by short follow-up and patient selection. Our aim was to determine predictors of long-term survival in patients hospitalized for heart failure and to develop a simple mortality risk score to estimate long-term mortality. METHODS: We prospectively followed up, during 10 years after hospitalization, 701 patients with confirmed heart failure from the HOLA (Heart failure: Observation of Local Admissions) registry. RESULTS: Mean age was 72.4 +/- 11.7 years; 45% were men. During follow-up, 465 patients died and 5 underwent heart transplantation. A total of 231 patients (33%) were alive and transplant-free at the end of follow-up (5.2 +/- 4.2 years). Median survival was 3.2 years. Multivariate analysis showed that six variables (age, previous renal disease, previous stroke, chronic obstructive pulmonary disease, left ventricular ejection fraction and aortic stenosis) were independent predictors of shorter survival time. By dichotomizing these variables, we obtained six factors with similar predictive values (hazard ratio between 1.5 and 2.0). A risk score for mortality was developed using these predictors by assigning 1 point to each and adding the total for each patient. Median survival for patients with 0, 1, 2, and 3 or more points were 6.5, 5.5, 3.3, and 1.7 years, respectively. One-year mortality rates were 15, 20, 28, and 49%, respectively. CONCLUSION: The prognosis of patients hospitalized with heart failure is highly variable. A simple risk score, based on six variables readily obtainable on admission can effectively stratify patients according to their predicted mortality.
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Martínez‐Sellés et al. (2010) conducted a cohort in Heart failure (n=701). Mortality risk score (age, renal disease, stroke, COPD, LVEF, aortic stenosis) vs. Lower risk score was evaluated on Long-term survival (HR between 1.5 and 2.0). A simple 6-point risk score effectively stratified long-term mortality in patients hospitalized for heart failure, with median survival ranging from 6.5 years (0 points) to 1.7 years (≥3 points).
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