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A Novel In-hospital Congestion Score to Risk Stratify Patients Admitted for Worsening Heart Failure (from ASCEND-HF)

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Abstract

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.

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Abbreviations

HF:

Heart failure

NT-proBNP:

Amino-terminal pro-B-type natriuretic peptide

CV:

Cardiovascular

JVP:

Jugular venous pulsation

SBP:

Systolic blood pressure

BUN:

Blood urea nitrogen

NRI:

Net reclassification index

IDI:

Integrated discrimination improvement

CCS:

Clinical congestion score

OR:

Odds ratio

CI:

Confidence interval

HR:

Hazard ratio

CIED:

Cardiac implantable electronic device

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Funding

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.

Author information

Authors and Affiliations

  1. Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA

    Rajeev Masson, Andrew P. Ambrosy & Kevin Kheder

  2. Division of Research, Kaiser Permanente Northern California, 2000 Broadway Street, Oakland, CA, 94612, USA

    Andrew P. Ambrosy

  3. Duke University Medical Center, Durham, NC, USA

    Marat Fudim, Adrian F. Hernandez & Robert J. Mentz

  4. Duke Clinical Research Institute, Durham, NC, USA

    Marat Fudim, Robert M. Clare, Adrian Coles, Adrian F. Hernandez & Robert J. Mentz

  5. Cleveland Clinic Foundation, Cleveland, OH, USA

    Randall C. Starling

  6. The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada

    Justin A. Ezekowitz

  7. INOVA Heart and Vascular Institute, Falls Church, VA, USA

    Christopher M. O’Connor

Authors
  1. Rajeev Masson
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  2. Andrew P. Ambrosy
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  3. Kevin Kheder
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  4. Marat Fudim
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  6. Adrian Coles
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  7. Adrian F. Hernandez
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  10. Christopher M. O’Connor
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  11. Robert J. Mentz
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Correspondence to Andrew P. Ambrosy.

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The authors declare that there are no conflicts of interest.

Informed Consent

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.

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Associate Editor Enrique Lara-Pezzi oversaw the review of this article

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Masson, R., Ambrosy, A.P., Kheder, K. et al. A Novel In-hospital Congestion Score to Risk Stratify Patients Admitted for Worsening Heart Failure (from ASCEND-HF). J. of Cardiovasc. Trans. Res. 13, 540–548 (2020). https://doi.org/10.1007/s12265-020-09954-x

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  • DOI: https://doi.org/10.1007/s12265-020-09954-x

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