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Magaldi M, Nogue E, Molinari N, De Luca N, Dupuy AM, Leclercq F, Pasquie JL, Roubille C, Mercier G, Cristol JP, Roubille F. Predicting One-Year Mortality after Discharge Using Acute Heart Failure Score (AHFS). J Clin Med 2024; 13:2018. [PMID: 38610783 PMCID: PMC11012877 DOI: 10.3390/jcm13072018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Acute heart failure (AHF) represents a leading cause of unscheduled hospital stays, frequent rehospitalisations, and mortality worldwide. The aim of our study was to develop a bedside prognostic tool, a multivariable predictive risk score, that is useful in daily practice, thus providing an early prognostic evaluation at admission and an accurate risk stratification after discharge in patients with AHF. Methods: This study is a subanalysis of the STADE HF study, which is a single-centre, prospective, randomised controlled trial enrolling 123 patients admitted to hospital for AHF. Here, 117 patients were included in the analysis, due to data exhaustivity. Regression analysis was performed to determine predictive variables for one-year mortality and/or rehospitalisation after discharge. Results: During the first year after discharge, 23 patients died. After modellisation, the variables considered to be of prognostic relevance in terms of mortality were (1) non-ischaemic aetiology of HF, (2) elevated creatinine levels at admission, (3) moderate/severe mitral regurgitation, and (4) prior HF hospitalisation. We designed a linear model based on these four independent predictive variables, and it showed a good ability to score and predict patient mortality with an AUC of 0.84 (95%CI: 0.76-0.92), thus denoting a high discriminative ability. A risk score equation was developed. During the first year after discharge, we observed as well that 41 patients died or were rehospitalised; hence, while searching for a model that could predict worsening health conditions (i.e., death and/or rehospitalisation), only two predictive variables were identified: non-ischaemic HF aetiology and previous HF hospitalisation (also included in the one-year mortality model). This second modellisation showed a more discrete discriminative ability with an AUC of 0.67 (95% C.I. 0.59-0.77). Conclusions: The proposed risk score and model, based on readily available predictive variables, are promising and useful tools to assess, respectively, the one-year mortality risk and the one-year mortality and/or rehospitalisations in patients hospitalised for AHF and to assist clinicians in the management of patients with HF aiming at improving their prognosis.
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Affiliation(s)
- Mariarosaria Magaldi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.M.)
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Nicolas Molinari
- Institute of Epidemiology and Public Health, INSERM, INRIA, CHU Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.M.)
| | - Anne-Marie Dupuy
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, 34295 Montpellier, France;
| | - Florence Leclercq
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Jean-Luc Pasquie
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Camille Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
- Department of Internal Medicine PhyMedExp CHU Montpellier, Montpellier University, 34090 Montpellier, France
| | - Grégoire Mercier
- Department of Statistics, Montpellier University Hospital, CEDEX 5, 34090 Montpellier, France;
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
- Laboratory of Biochemistry, Montpellier University Hospital, CEDEX 5, 34090 Montpellier, France
| | - François Roubille
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
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Ski CF, van der Wal MHL, Le Grande M, van Veldhuisen DJ, Lesman-Leegte I, Thompson DR, Middleton S, Cameron J, Jaarsma T. Patients with heart failure with and without a history of stroke in the Netherlands: a secondary analysis of psychosocial, behavioural and clinical outcomes up to three years from the COACH trial. BMJ Open 2019; 9:e025525. [PMID: 31462460 PMCID: PMC6720343 DOI: 10.1136/bmjopen-2018-025525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke. DESIGN AND PARTICIPANTS A secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure. SETTING Seventeen hospitals located across the Netherlands. OUTCOMES MEASURES Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular-cause and all-cause hospitalisations at 18 months, and all-cause mortality at 18 months and 3 years. RESULTS Compared with those without stroke, patients with HF with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27 to 6.28, p=0.011; OR 2.24, 95% CI 1.03 to 4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61 to 4.84, p<0.001; OR 2.00, 95% CI 1.09 to 3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05 to 3.11, p=0.034; OR 2.87, 95% CI 1.61 to 5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18 to 0.81, p=0.012; OR 0.35, 95% CI 0.17 to 0.72, p=0.004) at 12 and 18 months, higher rates of hospitalisations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07 to 1.91, p=0.016) at 3 years. CONCLUSIONS Patients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.
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Affiliation(s)
- Chantal F Ski
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Martje H L van der Wal
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | | | - Dirk J. van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivonne Lesman-Leegte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - David R Thompson
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Sandy Middleton
- Nursing Research Institute, Australian Catholic University, Sydney, New South Wales, Australia
| | - Jan Cameron
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
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