Duke Clinical Research Institute, Duke University Medical Center, 2400 North Pratt Street, Box 3356, Durham, North Carolina 27705, USA.
J Am Coll Cardiol. 2010 Mar 2;55(9):872-8. doi: 10.1016/j.jacc.2009.08.083.
Identifying high-risk heart failure (HF) patients at hospital discharge may allow more effective triage to management strategies.
Heart failure severity at presentation predicts outcomes, but the prognostic importance of clinical status changes due to interventions is less well described.
Predictive models using variables obtained during hospitalization were created using data from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial and internally validated by the bootstrapping method. Model coefficients were converted to an additive risk score. Additionally, data from FIRST (Flolan International Randomized Survival Trial) was used to externally validate this model.
Patients discharged with complete data (n = 423) had 6-month mortality and death and rehospitalization rates of 18.7% and 64%, respectively. Discharge risk factors for mortality included BNP, per doubling (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.15 to 1.75), cardiopulmonary resuscitation or mechanical ventilation during hospitalization (HR: 2.54, 95% CI: 1.12 to 5.78), blood urea nitrogen, per 20-U increase (HR: 1.22, 95% CI: 0.96 to 1.55), serum sodium, per unit increase (HR: 0.93, 95% CI: 0.87 to 0.99), age >70 years (HR: 1.05, 95% CI: 0.51 to 2.17), daily loop diuretic, furosemide equivalents >240 mg (HR: 1.49, 95% CI: 0.68 to 3.26), lack of beta-blocker (HR: 1.28, 95% CI: 0.68 to 2.41), and 6-min walk, per 100-foot increase (HR: 0.955, 95% CI: 0.99 to 1.00; c-index 0.76). A simplified discharge score discriminated mortality risk from 5% (score = 0) to 94% (score = 8). Bootstrap validation demonstrated good internal validation of the model (c-index 0.78, 95% CI: 0.68 to 0.83).
The ESCAPE study discharge risk model and score refine risk assessment after in-hospital therapy for advanced decompensated systolic HF, allowing clinicians to focus surveillance and triage for early life-saving interventions in this high-risk population. (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness [ESCAPE]; NCT00000619).
在出院时识别高危心力衰竭（HF）患者，可能有助于更有效地对管理策略进行分诊。
入院时 HF 严重程度可预测结局，但由于干预措施导致临床状况变化的预后重要性描述较少。
使用 ESCAPE（充血性心力衰竭和肺动脉导管有效性评估）试验中获得的住院期间变量创建预测模型，并通过自举法进行内部验证。将模型系数转换为加性风险评分。此外，还使用 FIRST（Flolan 国际随机生存试验）的数据对该模型进行外部验证。
出院时具有完整数据的患者（n=423），6 个月死亡率和死亡并再次入院率分别为 18.7%和 64%。死亡的出院危险因素包括 BNP，每翻倍（风险比[HR]：1.42，95%置信区间[CI]：1.15 至 1.75）、住院期间心肺复苏或机械通气（HR：2.54，95%CI：1.12 至 5.78）、血尿素氮，每增加 20-U（HR：1.22，95%CI：0.96 至 1.55）、血清钠，每增加 1 单位（HR：0.93，95%CI：0.87 至 0.99）、年龄>70 岁（HR：1.05，95%CI：0.51 至 2.17）、每日循环利尿剂，呋塞米当量>240mg（HR：1.49，95%CI：0.68 至 3.26）、缺乏β受体阻滞剂（HR：1.28，95%CI：0.68 至 2.41）、6 分钟步行，每增加 100 英尺（HR：0.955，95%CI：0.99 至 1.00；c 指数 0.76）。简化的出院评分可区分从 5%（评分=0）到 94%（评分=8）的死亡率风险。自举验证表明模型具有良好的内部验证（c 指数 0.78，95%CI：0.68 至 0.83）。
ESCAPE 研究出院风险模型和评分可改善住院治疗后晚期失代偿性收缩性 HF 的风险评估，使临床医生能够在这一高危人群中专注于早期挽救生命的干预措施的监测和分诊。（充血性心力衰竭和肺动脉导管有效性评估研究[ESCAPE]；NCT00000619）。
