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A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ÉLAN-HF Score
  1. Khibar Salah1,
  2. Wouter E Kok1,
  3. Luc W Eurlings2,
  4. Paulo Bettencourt3,
  5. Joana M Pimenta3,
  6. Marco Metra4,
  7. Antoni Bayes-Genis5,
  8. Valerio Verdiani6,
  9. Luca Bettari4,
  10. Valentina Lazzarini4,
  11. Peter Damman1,
  12. Jan G Tijssen1,
  13. Yigal M Pinto1
  1. 1Heart failure Research Center & Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Cardiology, University Hospital Maastricht, Maastricht, The Netherlands
  3. 3Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
  4. 4Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
  5. 5Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
  6. 6Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
  1. Correspondence to K Salah, Heart Failure Research Center, Meibergdreef 9, F3-105, Amsterdam 1105 AZ, The Netherlands; k.salah{at}


Background Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalisation.

Objective The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population.

Design Individual patient data meta-analyses of prospective cohort studies.

Setting Seven prospective cohorts with in total 1301 patients.

Patients Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge.

Main outcome measures The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge.

Results The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age ≥75 years, peripheral oedema, systolic blood pressure ≤115 mm Hg, hyponatremia at admission, serum urea of ≥15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p<0.001). A simplified model was obtained from the final Cox regression model by assigning weights to individual risk markers proportional to their relative risks. The risk score we designed identified four clinically significant subgroups. The pattern of increasing event rates with increasing score was confirmed in the validation group (BOT-AcuteHF, n=325, p<0.001).

Conclusions In patients hospitalised for ADHF, the addition of the discharge NT-proBNP values as well as the change in NT-proBNP to known risk markers, generates a relatively simple yet robust discharge risk score that importantly improves the prediction of adverse events.

  • Heart Failure

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