ORIGINAL ARTICLES

Heart failure and cardiomyopathy

A clinical and biochemical score for mortality prediction in patients with acute dyspnoea: derivation, validation and incorporation into a bedside programme

A L Baggish¹, D M Lloyd-Jones², J Blatt³, A M Richards⁴, J Lainchbury⁴, M O’Donoghue¹, R Sakhuja¹, A A Chen¹, J L Januzzi¹

¹ Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
² Department of Preventive Medicine and Bluhm Cardiovascular Institute, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
³ Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
⁴ Department of Medicine, Cardioendocrine Research Group, Christchurch Hospital, Christchurch, NZ

Dr J L Januzzi, Massachusetts General Hospital, Yawkey 5800, 55 Fruit Street, Boston, MA 02114, USA; JJanuzzi{at}Partners.org

Background: Risk stratification for patients with acute dyspnoea is a challenging task. No quantitative tool for mortality prediction among patients with acute dyspnoea is available.

Methods: 595 dyspnoeic subjects were enrolled in an emergency department. Clinical and biochemical factors independently predictive of death by 1 year were used to develop a mortality risk prediction tool.

Results: Seven factors comprised the final tool: age (x0.3), heart rate (x0.2), blood urea nitrogen (x0.3), New York Heart Association class (x5), amino-terminal pro-B-type natriuretic peptide (NT-proBNP) 986 pg/ml (18 points), systolic blood pressure <100 mm Hg (11 points) and presence of a murmur (11 points). A continuous rise in mortality was seen from 1.7% in the lowest score quintile (n = 118; score 48.5) to 43.1% in the highest quintile (n = 116, score 85.5; p<0.001 for trend). Receiver operating characteristic curve analysis of the score’s accuracy produced an area under the curve (AUC) of 0.82 (95% CI 0.78 to 0.85) with similar AUCs in subjects with acutely destabilised heart failure (AUC = 0.73, 95% CI 0.67 to 0.79) and those without (AUC = 0.83, 95% CI 0.77 to 0.85, p for the comparison = NS). The score was validated in a separate population of dyspnoeic patients (AUC = 0.73, 95% CI 0.64 to 0.82; p<0.001) and was incorporated into a computer program suitable for near-patient calculation.

Conclusion: A new risk stratification tool for acutely dyspnoeic patients has been derived and validated.

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• Steinhart, B., Thorpe, K. E., Bayoumi, A. M., Moe, G., Januzzi, J. L. Jr, Mazer, C. D. (2009). Improving the diagnosis of acute heart failure using a validated prediction model.. J Am Coll Cardiol 54: 1515-1521 [Abstract] [Full Text]