Abstract 14486: Validation of the Intermountain Risk Score and Get With the Guidelines-Heart Failure Score in Predicting 30 Day and 1 Year Mortality

Abstract

Background: The Intermountain Risk Score (IMRS) predicts mortality in heart failure (HF) patients utilizing common, inexpensive tests in conjunction with patient age and sex. IMRS has not been validated for Essentia Health (EH)’s patient population nor compared to various pre-existing scores in this population. Methods: Individuals were selected from the American Heart Association’s Get With The Guidelines®- HF (GWTG-HF) registry as patients to evaluate in a retrospective study. This patient population consists of consecutive inpatients age ≥18 admitted with a HF diagnosis at EH from 7/2017 through 6/2019. IMRS was derived using common HF laboratory measures (complete blood count and basic metabolic profile), age, and sex. EH is a large rural health care system in MN, WI, and ND. Results: A total of 703 individuals (mean age: 74.20, 44.38% female) were studied. The 30-day IMRS predicted 30 day mortality for both sexes (Females N=312: OR=1.19 (95% confidence interval: 1.08, 1.32) per +1, p<0.001; Males N=391: OR=1.23 (1.12, 1.36) per +1, p<0.001). The 1-year IMRS predicted 1-year mortality (Females: OR=1.14 (1.06, 1.23) per +1, p<0.001; Males: OR=1.28 (1.18, 1.38) per +1, p<0.001). Using sex-specific cut offs for IMRS, females had better 30-day risk stratification in moderate to high risk groups compared to low risk reference group (Mod-risk: OR=5.90 (1.35, 25.85), p=0.018; high-risk: OR=9.63 (2.12, 43.72), p=0.003) vs. men (Mod-risk: OR=1.52 (0.61, 3.79), p=0.37; high risk: OR=4.53 (1.92, 10.65), p<0.001). The GWTG-HF risk score was significant for 30-day (OR=1.29 (1.16, 1.44) per +1, p<0.001) and 1-year mortality (OR=1.23 (1.13, 1.35) per +1, p<0.001) but was only calculated in 292 patients (41.5%). Conclusions: The Intermountain Risk Score is a useful predictor of 30-day and 1-year mortality for heart failure patients in a large rural healthcare system. The GWTG-HF risk score also predicts 30-day and 1-year mortality but is often not calculated due to not all variables being collected at each hospital visit (i.e. ejection fraction). The IMRS risk score uses simple variables that most patients have on admission and future study to evaluate cost-effectiveness as a prospective tool for initial risk estimation is warranted.