AHEAD score — Long-term risk classification in acute heart failure

Abstract

BackgroundThe role of co-morbidities in the prognosis of patients hospitalized for AHF was examined using the AHEAD (A — atrial fibrillation, H — haemoglobin<130g/l for men and 120g/l for women (anaemia), E — elderly (age>70years), A — abnormal renal parameters (creatinine>130μmol/l), D — diabetes mellitus) scoring system. MethodsAHEAD — multicentre prospective Czech registry of AHF patients; GREAT registry — international cohort of AHF patients. Data from 5846 consecutive patients hospitalized for AHF (AHEAD registry; derivation cohort) were analysed to build the AHEAD score. Each risk factor of the AHEAD score was counted as 1 point. The model was validated externally using an international cohort of similar patients in the GREAT registry (6315). ResultsMain outcome was one year all-cause mortality. The mean age of patients was 72±12years, with 61.6% of patients aged >70years; 43.4% were women. Atrial fibrillation was present in 30.7%, anaemia in 38.2%, creatinine >130mmol/l (abnormal renal parameters) in 30.1%, and diabetes mellitus in 44.0%. The mean AHEAD score was 2.1. In patients with AHEAD scores of 0–5, the one-year mortality rates were 13.6%, 23.4%, 32.0%, 41.1%, 47.7%, and 58.2%, respectively (p<0.001), and the 90month mortality rates were 35.1%, 57.3%, 73.5%, 84.8%, 88.0%, and 91.7%, respectively (p<0.001). ConclusionThe AHEAD is a simple scoring system based on the analysis of co-morbidities for the estimation of the short and long term prognosis of patients hospitalized for AHF.