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Risk stratification for 1-year mortality in acute heart failure

Arenja, Nisha and Breidthardt, Tobias and Socrates, Thenral and Schindler, Christian and Heinisch, Corinna and Tschung, Christopher and Potocki, Mihael and Gualandro, Danielle and Mueller, Christian. (2011) Risk stratification for 1-year mortality in acute heart failure. Swiss Medical Weekly, 141. w13259.

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Official URL: http://edoc.unibas.ch/dok/A6002334

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Abstract

BACKGROUND: Simple tools for risk stratification of patients with acute heart failure (AHF) are an unmet clinical need, particularly regarding long-term mortality.
METHODS: We prospectively enrolled 610 consecutive patients presenting to the emergency department with AHF. The diagnosis of AHF was adjudicated by two independent cardiologists. The classification and regression tree (CART) analysis was used to develop a simple risk algorithm. This was internally validated by cross-validation.
RESULTS: One-year follow-up was complete in all patients (100%). A total of 201 patients (33%) died within 360 days. The CART analysis identified blood urea nitrogen (BUN) and age as the best single predictors of 1-year mortality and patients were categorised to three risk groups: high risk group (BUN <27.5 mg/dl and age <86 years), intermediate risk group (BUN <27.5 mg/dl and age >/= 86 years) and low risk group (BUN >/= 27.5 mg/dl). The Kaplan-Meier curves showed a significant increase in mortality in the high risk group compared with the lower risk groups (log-rank test p >0.001). The hazard ratio regarding 1-year mortality between patients identified as low and high risk was 2.0 (95% confidence interval, 1.7-2.4), with statistically significant differences between all risk groups (p >0.001). The likelihood-based 95%-confidence set for the age- and the urea-threshold is contained in the rectangular set defined by 25 mg/dl >/= urea threshold >/=30.6 mg/dl and 76 years >/= age threshold >/=96 years.
CONCLUSION: These results suggest that AHF patients at low, intermediate and high risk for death within 360 days can be easily identified using patient's demographics and laboratory data obtained at presentation. Application of this simple risk stratification algorithm may help to improve the management of these patients.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Public Health > Sozial- und Präventivmedizin
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Health Systems Research and Dynamic Modelling > Dynamical Modelling (Smith)
UniBasel Contributors:Schindler, Christian and Müller, Christian
Item Type:Article, refereed
Publisher:EMH Schweizerischer Arzteverlag
ISSN:1424-7860
e-ISSN:1424-3997
Note:Publication type according to Uni Basel Research Database: Journal article
Language:English
Identification Number:
Last Modified:24 Aug 2017 15:01
Deposited On:08 Nov 2012 16:21

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