A Novel In-hospital Congestion Score to Risk Stratify Patients Admitted for Worsening Heart Failure (from ASCEND-HF)
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Patients hospitalized for heart failure (HF) remain at high risk for early readmission. A post hoc analysis was performed of the biomarker substudy of the ASCEND-HF trial. An in-hospital congestion score was derived using orthopnea, pedal edema, and NT-proBNP levels. Its added prognostic value beyond traditional risk factors was assessed by determining the net reclassification index (NRI). Study participants (n = 884) had a median age (years) of 67 (55–77), 68% were male, and the median (25th–75th) ejection fraction (%) was 26 (20–40). After adjustment, increasing congestion score was associated with 30-day all-cause mortality or HF hospitalization (odds ratio = 1.51, 95% confidence interval [CI] 1.28–1.77, p < 0.001) and 180-day all-cause mortality (hazard ratio = 1.48, 95% CI 1.28–1.72, p < 0.001). However, adding the congestion score to the multivariable model did not significantly impact the NRI. A higher in-hospital congestion score portended a poor short-term prognosis but did not significantly reclassify risk.
KeywordsCongestion Natriuretic peptides Heart failure Readmission Mortality
Amino-terminal pro-B-type natriuretic peptide
Jugular venous pulsation
Systolic blood pressure
Blood urea nitrogen
Net reclassification index
Integrated discrimination improvement
Clinical congestion score
Cardiac implantable electronic device
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Scios Inc. (Mountain View, CA, USA) provided financial and material support for the ASCEND-HF trial. Database management and statistical analysis was performed by the Duke Clinical Research Institute.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that there are no conflicts of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.
The authors take responsibility for the manuscript’s integrity, and had complete control and authority over its preparation and the decision to publish.
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