Department of Cardiovascular Diseases Mayo Clinic Rochester MN.
Department of Health Sciences Research Mayo Clinic Rochester MN.
J Am Heart Assoc. 2020 Feb 4;9(3):e012439. doi: 10.1161/JAHA.119.012439. Epub 2020 Jan 28.
Background The cardiac intensive care unit (CICU) population is no longer composed of only patients with acute coronary syndromes, and includes those with acute heart failure and multiple comorbidities. We hypothesized that the GWTG-HF (Get With The Guidelines-Heart Failure) risk score that predicts inpatient mortality in hospitalized patients with heart failure would predict mortality in CICU patients. Methods and Results We retrospectively analyzed CICU patients at a tertiary care hospital from 2007 to 2015. The GWTG-HF risk score was calculated at CICU admission. As a secondary analysis, the EFFECT (Enhanced Feedback for Effective Cardiac Treatment), OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure), and ADHERE (Acute Decompensated Heart Failure National Registry) risk scores were calculated. Kaplan-Meier survival analysis and the area under the receiver operating characteristic curve value were determined for inpatient and 1-year mortality. The GWTG-HF risk score was calculated in 9532 (95%) patients, with a median value of 40 (interquartile range, 35-47). Inpatient mortality occurred in 824 (8.6%) patients, and 2075 (21.8%) patients died by 1 year. Patients who died in hospital had a significantly higher mean GWTG-HF score (47.7 versus 40.2; <0.001). Inpatient and 1-year mortality increased in each GWTG-HF risk score quartile (<0.0001). Discrimination of the GWTG-HF, EFFECT, OPTIMIZE-HF, and ADHERE risk scores was assessed using area under the receiver operating characteristic curve values for hospital mortality, and were similar for all risk scores (0.72-0.74; >0.05). The Hosmer-Lemeshow statistic suggested poor calibration for hospital mortality by the GWTG-HF risk score (<0.001). Conclusions The GWTG-HF risk score and other heart failure prediction tools demonstrate good discrimination for inpatient and 1-year mortality in a heterogeneous cohort of CICU patients. Our study emphasizes that prognostic variables overlap in cardiac patients, regardless of the admission diagnosis.
心脏重症监护病房（CICU）的患者群体不再仅由急性冠状动脉综合征患者组成，还包括急性心力衰竭和多种合并症患者。我们假设，预测住院心力衰竭患者住院内死亡率的 GWTG-HF（Get With The Guidelines-Heart Failure）风险评分也可预测 CICU 患者的死亡率。
我们回顾性分析了 2007 年至 2015 年在一家三级医院的 CICU 患者。在 CICU 入院时计算 GWTG-HF 风险评分。作为次要分析，计算 EFFECT（有效心脏治疗的强化反馈）、OPTIMIZE-HF（有组织的启动住院心力衰竭患者救生治疗计划）和 ADHERE（急性失代偿性心力衰竭国家注册）风险评分。通过 Kaplan-Meier 生存分析和接受者操作特征曲线下面积值确定住院内和 1 年死亡率。在 9532 例（95%）患者中计算了 GWTG-HF 风险评分，中位数为 40（四分位距，35-47）。824 例（8.6%）患者在院内死亡，2075 例（21.8%）患者在 1 年内死亡。院内死亡患者的平均 GWTG-HF 评分明显更高（47.7 比 40.2；<0.001）。每个 GWTG-HF 风险评分四分位数的住院内和 1 年死亡率均增加（<0.0001）。使用接受者操作特征曲线下面积值评估 GWTG-HF、EFFECT、OPTIMIZE-HF 和 ADHERE 风险评分对医院死亡率的判别能力，所有风险评分的结果相似（0.72-0.74；>0.05）。Hosmer-Lemeshow 统计量表明，GWTG-HF 风险评分对医院死亡率的校准效果不佳（<0.001）。
GWTG-HF 风险评分和其他心力衰竭预测工具在异质的 CICU 患者群体中对住院内和 1 年死亡率具有良好的判别能力。我们的研究强调，无论入院诊断如何，心脏患者的预后变量均存在重叠。
