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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
  1. A L Baggish1,
  2. D M Lloyd-Jones2,
  3. J Blatt3,
  4. A M Richards4,
  5. J Lainchbury4,
  6. M O’Donoghue1,
  7. R Sakhuja1,
  8. A A Chen1,
  9. J L Januzzi1
  1. 1
    Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
  2. 2
    Department of Preventive Medicine and Bluhm Cardiovascular Institute, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
  3. 3
    Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4
    Department of Medicine, Cardioendocrine Research Group, Christchurch Hospital, Christchurch, NZ
  1. Dr J L Januzzi, Massachusetts General Hospital, Yawkey 5800, 55 Fruit Street, Boston, MA 02114, USA; JJanuzzi{at}Partners.org

Abstract

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 (×0.3), heart rate (×0.2), blood urea nitrogen (×0.3), New York Heart Association class (×5), 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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Footnotes

  • Competing interests: JLJ and AMR have received grant support, consulting income, and speaking fees from Roche Diagnostics.

  • Ethics approval: Ethics committee approval obtained.

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