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March 6, 2019Circulation Journal21 citationsOpen Access

Simple Risk Score to Predict Survival in Acute Decompensated Heart Failure ― A2B Score ―

YNYasuki NakadaRKRika KawakamiSMShouji Matsushima

Key Result

The A2B score, based on age, hemoglobin, and BNP at discharge, effectively stratified 2-year survival rates in patients with acute decompensated heart failure from 97.8% in the extremely low-risk group to 45.2% in the high-risk group.

Study Design

Type

Cohort (n=1,281)

Multicenter

Yes

Structured PICO

Does the A2B risk score predict 2-year survival in patients discharged after acute decompensated heart failure?

P
Population
1,281 patients hospitalized for acute decompensated heart failure across two Japanese registries, followed for 2 years to derive and validate a survival risk score.
E
Exposure
A2B risk score calculation at discharge (based on age, hemoglobin, and brain natriuretic peptide [BNP])
O
Outcome
All-cause death during the 2-year follow-up, excluding in-hospital deathhard clinical

The A2B score, utilizing age, hemoglobin, and BNP, provides a simple and effective tool for predicting 2-year survival in patients discharged after acute decompensated heart failure.

Main Result

Effect estimate: C-statistic 0.711 (95% CI 0.671-0.751)

p-value: p=<0.0001

Limitations

  • Performed using Japan registries and involved only Japanese patients; Western populations were not assessed.
  • Could not include all registered patients because of data loss.
  • Young patients who require an LV assist device or heart transplantation are rarely included, and it is unknown whether these data apply to such a limited group.
  • Performed using Japan registries and involved only Japanese patients; Western populations were not assessed
  • Could not include all registered patients because of data loss
  • Young patients who require an LV assist device or heart transplantation are rarely included

Abstract

BACKGROUND: Prognosis after acute decompensated heart failure (ADHF) is poor. An appropriate risk score that would allow for improved care and treatment of ADHF patients after discharge, however, is lacking. METHODS AND RESULTS: B score (extremely low, 0; low, 1-2; medium, 3-4; high, 5-6). For the extremely low-risk group, the 2-year survival rate was 97.8%, compared with 84.5%, 66.1%, and 45.2% for the low-, medium-, and high-risk groups, respectively. Using the JCARE-CARD as a validation model, for the extremely low-risk group, the 2-year survival was 95.4%, compared with 90.2%, 75.0%, and 55.6% for the low-, medium-, and high-risk groups, respectively. CONCLUSIONS: B score is useful for estimating survival rate in ADHF patients at discharge.

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Cite This Study

Nakada et al. (2019) conducted a cohort in Acute Decompensated Heart Failure (ADHF) (n=1,281). A2B score (Age, Hemoglobin, BNP) vs. Different risk strata (extremely low, low, medium, high) was evaluated on All-cause death during 2-year follow-up, excluding in-hospital death (C-statistic 0.711, 95% CI 0.671-0.751, p=<0.0001). The A2B score, based on age, hemoglobin, and BNP at discharge, effectively stratified 2-year survival rates in patients with acute decompensated heart failure from 97.8% in the extremely low-risk group to 45.2% in the high-risk group.

synapsesocial.com/papers/6a884e6a4c82be800eeb56b4https://doi.org/10.1253/circj.cj-18-1116
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