The GRACE (Global Registration of Acute Coronary Events) score predicts heart failure readmission

Abstract

Purpose: The GRACE score is an established predictor of recurrent myocardial infarction/death following admission to hospital with acute coronary syndrome. Whether GRACE also predicts readmission with heart failure is unknown. Methods: In a large consecutive case-series of patients with acute coronary syndrome admitted to a single centre over a 5 year period, we evaluated the utility of the GRACE score for predicting readmission to hospital with a diagnosis of heart failure. Readmissions were identified via linkage to a national healthcare utilisation database. Heart failure readmission was defined as the presence of ICD10 code I50. Hazard ratios (HR) were estimated by quintile of GRACE score in unadjusted Cox regression models, and adjusting for age, gender and the presence of heart failure on the index admission. The area under the receiver operating characteristic curve (AUC) was estimated. The net reclassification index was calculated using cut-offs of 1,5,10 and 20% 1-year risk of heart failure readmission. Results: 2036 patients, mean age 66, 66% male, had a total of 243 events over 3.8 median years of follow-up. 44 patients had heart failure on the index admission. Compared to the lowest quintile, patients in the highest GRACE score quintile had more heart failure readmissions (82 vs 17) and a lower time to first heart failure readmission (1.5 vs 5.9 years, HR 8.48, 95% CI 5.03-14.3). Associations were also evident after adjusting for age (HR 4.89, 95% CI 2.69-8.79) and heart failure on index admission (3.84, 95% CI 2.10-7.02). The AUC for GRACE score, age and heart failure on index admission combined was 0.71. The net reclassification index (NRI) for the addition of GRACE score to age was 17.4% (13.7 for cases, NRI 3.7 for controls). Similar results were obtained after excluding patients with heart failure on the index admission. View this table: Rate of heart failure readmission by quintile of GRACE score Conclusions: When added to age, gender and heart failure on initial admission, the GRACE score improves prediction of heart failure readmission among people admitted to hospital with acute coronary syndrome.