Abstract
Background: The Get With the Guidelines-Heart Failure (GWTG-HF) risk score was recently developed to predict in-hospital mortality in patients (pts) admitted with acute decompensated heart failure (ADHF). On the other hand, comorbidity is also associated with poor clinical outcome in HF patients. However, there is no information available on the prognostic value of combining GWTG-HF risk score and comorbidity in patients admitted for ADHF. Methods: We prospectively studied 396 ADHF patients with survival discharge. GWTG risk score consists of 7 admission variables (blood urea nitrogen, systolic blood pressure, age, sodium, heart rate, race, and lung disease). Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI) which is commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. The endpoint was all-cause death (ACD). Results: During a follow-up period of 2.2±1.4 years, 114 patients had ACD. At multivariate Cox analysis, GWTG-HF risk score (p<0.0001) and ACCI (p=0.0077) were significantly and independently associated with ACD, after the adjustment with sex, NYHA class, history of worsening heart failure hospitalization, LVEF, eGFR and plasma BNP level at the discharge. Patients with both higher GWTG-HF risk score (>39 by ROC analysis, AUC 0.714 [95%CI 0.667-0.758]) and higher CCI (>5 by ROC analysis, AUC 0.653 [95%CI 0.604-0.700]) had a significantly increased risk of ACD than either or none of them (46% vs 28% vs 7%, p<0.0001). Adjusted hazard ratio in patients with both higher GWTG-HF risk score and ACCI was 9.4 (95%CI 4.3-20.6), which was two-fold of that in patients with either of them (4.5[95%CI 2.0-10.1]). Conclusions: GWTG-HF risk score and comorbidity had an prognostic incremental value in patients admitted for ADHF.
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