Abstract
Background: Irreversible worsening of cardiac function is an adverse event associated with significant morbidity among patients with acute decompensated heart failure (ADHF). We aimed to develop a parsimonious model which is simple to use in clinical settings for the prediction of the risk of irreversible worsening of cardiac function.Methods: A total of 871 ADHF patients were enrolled in this study. Data for each patient were collected from the medical records. Irreversible worsening of cardiac function included cardiac death within 30-days of patient hospitalization, implantation of a left ventricular assistance device, or emergency heart transplantation. We performed LASSO regression for variable selection to derive a multivariable logistic regression model. Five candidate predictors were selected to derive the final prediction model. The prediction model was verified using C-statistics, calibration curve, and decision curve.Results: Irreversible worsening of cardiac function occurred in 7.8% of the patients. Advanced age, NYHA class, high blood urea nitrogen, hypoalbuminemia, and vasopressor use were its strongest predictors. The prediction model showed good discrimination C-statistic value, 0.866 (95% CI, 0.817–0.907), which indicated good identical calibration and clinical efficacy.Conclusion: In this study, we developed a prediction model and nomogram to estimate the risk of irreversible worsening of cardiac function among ADHF patients. The findings may provide a reference for clinical physicians for detection of irreversible worsening of cardiac function and enable its prompt management.
Highlights
Irreversible worsening of cardiac function is an adverse event associated with significant morbidity among patients with acute decompensated heart failure (ADHF)
The Transparent Reporting for Individual Prognosis or Diagnosis (TRIPOD) recommendation was used as the guideline for the development and validation of the multivariable prediction model [11]
We considered the events per variables (EPV) ratio between 5 and 10 acceptable, with EPV of 10 as the optimal number to minimize the overfitting of the regression model [13]
Summary
Irreversible worsening of cardiac function is an adverse event associated with significant morbidity among patients with acute decompensated heart failure (ADHF). Patients hospitalized with acute decompensated heart failure (ADHF) have a high risk of mortality, with 30-day mortality rates approaching 10% [2]. Some patients are discharged from the hospital after treatment, while in others deterioration of heart failure occurs during. Patients who experienced inhospital worsening heart failure had high 30-day mortality (29.7%) [3]. Risk prediction models are often used to classify patients and simplify treatment decisions. They help physicians predict prognoses and interpret the results of prognostic studies to improve the level of care for inpatients with heart failure
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