American Heart Association Get With the Guidelines-Heart Failure (GWTG-HF) risk score is a useful multivariable score model to predict mortality in patients with acutely decompensated heart failure. We prospectively investigated the prognostic value of combined assessment of GWTG-HF risk score with D-dimer and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Methods:
On admission, we measured plasma D-dimer and NT-proBNP levels in 1735 patients (mean age, 75 yrs) hospitalized for worsening heart failure. GWTG-HF risk score, including race, age, systolic blood pressure, heart rate, blood urea nitrogen level, sodium concentration, and presence of chronic obstructive pulmonary disease, was calculated at admission.
Results:
During a follow-up period of 12 month after admission, 371 (21%) deaths occurred. Patients who died were older (mean: 78 vs. 74 years; P<0.001), had a higher frequency of NYHA functional class IV (63 vs. 49%; P<0.001), higher values of GWTG-HF risk score (43 vs. 38; P<0.001), D-dimer (2.90 vs. 1.30 μg/mL; P<0.001), and NT-proBNP (7202 vs. 3689 pg/mL; P<0.001) than survivors. In the multivariate logistic analysis, elevation (more than the highest tertile value) in D-dimer (>2.5 μg/mL; P<0.001), NT-proBNP (>7399 pg/mL; P<0.001), and GWTG-HF risk score (>42 point; P<0.001) were independently associated with mortality within 12 months. Furthermore, adding D-dimer and NT-proBNP to the GWTG-HF risk score improved the C-index (P<0.01), net reclassification improvement (P<0.001), and integrated discrimination improvement (P<0.001) greater than GWTG-HF risk score alone. The number of elevation in GWTG-HF risk score, D-dimer, and NT-proBNP was strongly associated with a higher risk of mortality within 12 months (
Figure
).
Conclusion:
The combined assessment of GWTG-HF risk score with D-dimer and NT-proBNP facilitates the risk stratification for mortality within 12 months in patients hospitalized for worsening heart failure.
A Validated Risk Score for In-Hospital Mortality in Patients With Heart Failure From the American Heart Association Get With the Guidelines Program
