Risk stratification in heart failure decompensation in the community: HEFESTOS score

Aims: Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensatio...

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Autores: Verdú Rotellar, Jose María, Abellana Sangrà, Rosa Mari, Vaillant-Roussel, Helene, Gril Jevsek, Lea, Assenova, Radost, Kasuba Lazic, Djurdjica, Torsza, Peter, Glynn, Liam George, Lingner, Heidrun, Demurtas, Jacopo, Thulesius, Hans, Muñoz Pérez, Miguel Ángel, HEFESTOS group
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/183271
Acceso en línea:https://hdl.handle.net/2445/183271
Access Level:acceso abierto
Palabra clave:Insuficiència cardíaca
Avaluació del risc per la salut
Heart failure
Health risk assessment
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spelling Risk stratification in heart failure decompensation in the community: HEFESTOS scoreVerdú Rotellar, Jose MaríaAbellana Sangrà, Rosa MariVaillant-Roussel, HeleneGril Jevsek, LeaAssenova, RadostKasuba Lazic, DjurdjicaTorsza, PeterGlynn, Liam GeorgeLingner, HeidrunDemurtas, JacopoThulesius, HansMuñoz Pérez, Miguel ÁngelHEFESTOS groupInsuficiència cardíacaAvaluació del risc per la salutHeart failureHealth risk assessmentAims: Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings. Methods and results: HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the derivation cohort and 58.8% in the validation one (P = 0.004). Mortality/hospitalization during the first 30 days after a decompensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles (OR: 2.35; P = 0.01), New York Heart Association functional class III/IV (OR: 2.11; P = 0.001), oxygen saturation ≤ 90% (OR: 4.98; P < 0.001), heart rate > 100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45; P < 0.001). The model showed an area under the curve (AUC) of 0.807, 95% confidence interval (CI): [0.770; 0.845] in the derivation cohort and AUC 0.73, 95% CI: [0.660; 0.808] in the validation one. No significant differences between both cohorts were observed (P = 0.08). Regarding probability of hospitalization/death, three risk groups were defined: low <5%, medium 5-20%, and high >20%. Outcome incidence was 2.7% for the low-risk group, 12.8% for medium risk, and 46.2% for high risk in the derivation cohort, and 9.1%, 12.9%, and 39.6% in the validation one. Conclusions: The HEFESTOS score, based on variables easily accessible in a community setting and validated in an external European cohort, properly predicted the risk of death/hospitalization during the first 30 days after an HF decompensation episode.John Wiley & Sons2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/183271Articles publicats en revistes (Fonaments Clínics)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1002/ehf2.13707ESC Heart Failure, 2021, vol. 9, num. 1, p. 606-613https://doi.org/10.1002/ehf2.13707cc-by-nc-nd (c) Verdú Rotellar, Jose Maria. et al., 2021https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1832712026-05-27T06:46:51Z
dc.title.none.fl_str_mv Risk stratification in heart failure decompensation in the community: HEFESTOS score
title Risk stratification in heart failure decompensation in the community: HEFESTOS score
spellingShingle Risk stratification in heart failure decompensation in the community: HEFESTOS score
Verdú Rotellar, Jose María
Insuficiència cardíaca
Avaluació del risc per la salut
Heart failure
Health risk assessment
title_short Risk stratification in heart failure decompensation in the community: HEFESTOS score
title_full Risk stratification in heart failure decompensation in the community: HEFESTOS score
title_fullStr Risk stratification in heart failure decompensation in the community: HEFESTOS score
title_full_unstemmed Risk stratification in heart failure decompensation in the community: HEFESTOS score
title_sort Risk stratification in heart failure decompensation in the community: HEFESTOS score
dc.creator.none.fl_str_mv Verdú Rotellar, Jose María
Abellana Sangrà, Rosa Mari
Vaillant-Roussel, Helene
Gril Jevsek, Lea
Assenova, Radost
Kasuba Lazic, Djurdjica
Torsza, Peter
Glynn, Liam George
Lingner, Heidrun
Demurtas, Jacopo
Thulesius, Hans
Muñoz Pérez, Miguel Ángel
HEFESTOS group
author Verdú Rotellar, Jose María
author_facet Verdú Rotellar, Jose María
Abellana Sangrà, Rosa Mari
Vaillant-Roussel, Helene
Gril Jevsek, Lea
Assenova, Radost
Kasuba Lazic, Djurdjica
Torsza, Peter
Glynn, Liam George
Lingner, Heidrun
Demurtas, Jacopo
Thulesius, Hans
Muñoz Pérez, Miguel Ángel
HEFESTOS group
author_role author
author2 Abellana Sangrà, Rosa Mari
Vaillant-Roussel, Helene
Gril Jevsek, Lea
Assenova, Radost
Kasuba Lazic, Djurdjica
Torsza, Peter
Glynn, Liam George
Lingner, Heidrun
Demurtas, Jacopo
Thulesius, Hans
Muñoz Pérez, Miguel Ángel
HEFESTOS group
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Insuficiència cardíaca
Avaluació del risc per la salut
Heart failure
Health risk assessment
topic Insuficiència cardíaca
Avaluació del risc per la salut
Heart failure
Health risk assessment
description Aims: Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings. Methods and results: HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the derivation cohort and 58.8% in the validation one (P = 0.004). Mortality/hospitalization during the first 30 days after a decompensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles (OR: 2.35; P = 0.01), New York Heart Association functional class III/IV (OR: 2.11; P = 0.001), oxygen saturation ≤ 90% (OR: 4.98; P < 0.001), heart rate > 100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45; P < 0.001). The model showed an area under the curve (AUC) of 0.807, 95% confidence interval (CI): [0.770; 0.845] in the derivation cohort and AUC 0.73, 95% CI: [0.660; 0.808] in the validation one. No significant differences between both cohorts were observed (P = 0.08). Regarding probability of hospitalization/death, three risk groups were defined: low <5%, medium 5-20%, and high >20%. Outcome incidence was 2.7% for the low-risk group, 12.8% for medium risk, and 46.2% for high risk in the derivation cohort, and 9.1%, 12.9%, and 39.6% in the validation one. Conclusions: The HEFESTOS score, based on variables easily accessible in a community setting and validated in an external European cohort, properly predicted the risk of death/hospitalization during the first 30 days after an HF decompensation episode.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/183271
url https://hdl.handle.net/2445/183271
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1002/ehf2.13707
ESC Heart Failure, 2021, vol. 9, num. 1, p. 606-613
https://doi.org/10.1002/ehf2.13707
dc.rights.none.fl_str_mv cc-by-nc-nd (c) Verdú Rotellar, Jose Maria. et al., 2021
https://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by-nc-nd (c) Verdú Rotellar, Jose Maria. et al., 2021
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv John Wiley & Sons
publisher.none.fl_str_mv John Wiley & Sons
dc.source.none.fl_str_mv Articles publicats en revistes (Fonaments Clínics)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,300719

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