Prognostic Scores for Risk Stratification in Patients with Acute Heart Failure

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Abstract

Background: Heart failure is a common, progressive and potentially lethal condition. An adequate risk assessment in acute cases might optimize care and resources.
Objective: The aim of this study was to apply three of the existent risk scores to predict in-hospital mortality in patients with acute heart failure in order to understand their performance.
Methods: This prognostic study included patients hospitalized by the department of internal medicine with diagnosis of decompensated heart failure between February 2010 and March 2013. Three risk scores were used to evaluate in-hospital mortality: the ADHERE decision tree, the OPTIMIZE-HF score and the GWTG-HF score. Contingency tables were constructed using the performance of the different cutoff points and the ROC curves of each score; then, the areas under the curve were calculated.
Results: Score results were calculated in 379 patients. Mean age was 75 years, 54% were women, 79% had hypertension, and 24% were diabetics. The area under the curve for the three risk scores was 0.63 (95% CI, 0.53-0.73) for OPTIMIZE-HF, 0.57 (95% CI,0.49-0.65) for GWTG-HF and 0.58 (95% CI, 0.47-0.68) for ADHERE.
Conclusion: In a population of patients hospitalized for decompensated heart failure, the ADHERE, OPTIMIZE and GWTG-HF risk scores showed poor discrimination ability to predict in-hospital mortality