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. 2013 Nov;166(5):895-903.e1.
doi: 10.1016/j.ahj.2013.09.002. Epub 2013 Oct 7.

Risk stratification for death and all-cause hospitalization in heart failure clinic outpatients

Scott L Hummel  1 , Hussam H Ghalib, David Ratz, Todd M Koelling
Affiliations

Risk stratification for death and all-cause hospitalization in heart failure clinic outpatients

Scott L Hummel et al. Am Heart J. 2013 Nov.

Abstract

Background: Most heart failure (HF) risk stratification models were developed for inpatient use, and available outpatient models use a complex set of variables. We hypothesized that routinely collected clinical data could predict the 6-month risk of death and all-cause medical hospitalization in HF clinic outpatients.

Methods and results: Using a quality improvement database and multivariable Cox modeling, we derived the Heart Failure Patient Severity Index (HFPSI) in the University of Michigan HF clinic (UM cohort, n = 1,536; 314 reached primary outcome). We externally validated the HFPSI in the Ann Arbor Veterans' Affairs HF clinic (VA cohort, n = 445; 106 outcomes) and explored "real-time" HFPSI use (VA-RT cohort, n = 486; 141 outcomes) by tracking VA patients for 6 months from their most recently calculated HFPSI, rather than using an arbitrary start date for the cohort. The HFPSI model included blood urea nitrogen, B-type natriuretic peptide, New York Heart Association class, diabetes status, history of atrial fibrillation/flutter, and all-cause hospitalization within the prior 1 and 2 to 6 months. The concordance c statistics in the UM/VA/VA-RT cohorts were 0.71/0.68/0.74. Kaplan-Meier curves and log-rank testing demonstrated excellent risk stratification, particularly between a large, low-risk group (40% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 8%/12%/12%) and a small, high-risk group (10% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 57%/58%/79%).

Conclusions: The HFPSI uses readily available data to predict the 6-month risk of death and/or all-cause medical hospitalization in HF clinic outpatients and could potentially help allocate specialized HF resources within health systems.

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Figures

Figure 1
Figure 1
Cohort composition and time frame for outcome assessment. Abbreviations: LVAD, left ventricular assist device; UM, University of Michigan; VA, Veterans Affairs; VA-RT, Veterans Affairs Real-Time.
Figure 2
Figure 2
Survival free of death and all-cause medical hospitalization, HFPSI score decile groups.
Figure 3
Figure 3
Survival free of death and all-cause medical hospitalization, HFPSI integer score group.
See this image and copyright information in PMC

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