Abstract 13891: Prognostic Value of Simple Risk Index at Discharge in Patients Admitted for Acute Decompensated Heart Failure With Reduced or Preserved Left Ventricular Ejection Fraction

Abstract

Backgrounds: Increased heart rate (HR) and low systolic blood pressure (SBP) are associated with adverse clinical outcomes in patients (pts) admitted for acute decompensated heart failure (ADHF). It has been reported that simple risk index (SRI) based on easily assessed clinical characteristics (age, HR, and SBP) is useful for the prediction of short-term mortality in pts with acute myocardial infarction. However, there is no information available on the prognostic significance of pre-discharge SRI in pts admitted for ADHF relating to reduce or preserved left ventricular ejection fraction (HFrEF or HFpEF). Methods and Results: We studied 303 consecutive ADHF pts discharged with survival (HFrEF(LVEF<50%);n=163, HFpEF(LVEF≥50%);n=140), and obtained clinical characteristics, conventional hemodynamic parameters and laboratory data. SRI was calculated as (HRх[age/10] 2 )/SBP. During a follow up period of 4.2±3.3 yrs, 96 pts had all-cause death. In HFrEF group, at multivariate Cox analysis, SRI at the discharge (adjusted hazard ratio:1.055[95%CI 1.029 to 1.081], p<0.0001) was significantly associated with total mortality, independently of prior heart failure hospitalization, and serum sodium and albumin levels after adjustment for anemia and renal function. The mortality risk significantly increased by SRI tertiles (lowest tertile [<26.3]: 19%, middle tertile [26.3-36.3]: 38% and highest tertile [>36.3]: 54%, p=0.0001). In HFpEF group, SRI at the discharge (adjusted hazard ratio:1.065[95%CI 1.022 to 1.109], p=0.0026) was also significantly associated with total mortality, independently of anemia and serum sodium level after adjustment for renal function. Pts with highest and middle SRI tertile had a increased risk of total mortality than those with lowest tertile (30% vs 28% vs 13%, p=0.002, respectively). Conclusion: SRI at the discharge would provide the long-term prognostic information in ADHF pts, regardless of HFrEF or HFpEF.