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Assessment of acute heart failure prognosis: the promising role of prognostic models and biomarkers

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Abstract

Numerous models and biomarkers have been proposed to estimate prognosis and improve decision-making in patients with acute heart failure (AHF). The present literature review provides a critical appraisal of externally validated prognostic models in AHF, combining clinical data and biomarkers. We perform a literature review of clinical studies, using the following terms: “acute heart failure,” “acute decompensated heart failure,” “prognostic models,” “risk scores,” “mortality,” “death,” “hospitalization,” “admission,” and “biomarkers.” We searched MEDLINE and EMBASE databases from 1990 to 2020 for studies documenting prognostic models in AHF. External validation of each prognostic model to another AHF cohort, containing at least one biomarker, was prerequisites for study selection. Among 358 initially screened studies, 9 of them fulfilled all searching criteria. The majority of prognostic models were simplified, including a narrow number of variables (up to 10), with good performance regarding calibration and discrimination (c-statistics > 0.65). Unfortunately, the derived and validated cohorts showed a wide variety in patients’ characteristics (e.g., cause of AHF and therapy). Moreover, the prognostic models used various time-points and a plethora of combinations of variables determining different cut-off values. Although the application of valid prognostic models in AHF population is quite promising, a precise methodological approach should be set for the derivation and validation of prognostic models in AHF with unified characteristics to establish an effective performance in clinical practice.

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Funding

This work was partially funded by the British Heart Foundation (grant no. PG/17/49/33099) for the project titled “Systematic Reviews on the Prognostic Role of Biomarkers in Heart Failure (proBHF).”

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Authors and Affiliations

  1. Medical School, University of Cyprus, 215/6 Old road Lefkosias-Lemesou, 2029, Aglantzia, Nicosia, Cyprus

    Nikolaos P. E. Kadoglou

  2. Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK

    Nikolaos P. E. Kadoglou & Marialena Trivella

  3. 2nd Department of Cardiology, Attikon” University Hospital, National & Kapodistrian University of Athens, Athens, Greece

    John Parissis

  4. General Hospital of Athens “G. Gennimatas”, Athens, Greece

    Apostolos Karavidas

  5. Second Cardiology Department, “Hippokration” Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Ioannis Kanonidis

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Kadoglou, N.P.E., Parissis, J., Karavidas, A. et al. Assessment of acute heart failure prognosis: the promising role of prognostic models and biomarkers. Heart Fail Rev 27, 655–663 (2022). https://doi.org/10.1007/s10741-021-10122-9

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