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New bedside evaluation tool gauges mortality risk in patients hospitalized with heart failure


Cardiovascular Medicine 

UCLA Researchers have developed a new evaluation tool that can predict mortality risk in patients hospitalized with heart failure. The new tool – used right at the bedside upon hospital admission – will help clinicians quickly decide which patients have a higher mortality risk and, therefore, may require more monitoring and earlier, more intensive intervention.

The study, reported in the February 2, 2005 issue of the Journal of the American Medical Association, demonstrates the usefulness of this new tool that combines three simple measures obtained through admission laboratory blood tests and by taking vital signs.

Top mortality risk factors identified

Using data from the Acute Decompensated Heart Failure National Registry (ADHERE) – a national registry of more than 100,000 heart failure patients – researchers developed a risk model after analyzing 33,046 hospitalizations. The model was developed using a relatively new statistical technique known as classification and regression tree analysis. The validity of the model then was tested using data from an additional 32,229 hospitalizations.

Researchers evaluated 39 possible factors as survival indicators upon hospital admission and found that the best single predictor for mortality was a high blood urea nitrogen level (above 43 mg/dL), followed by a low systolic blood pressure (below 115 mm Hg) and a high serum creatinine (higher than 2.75 mg/dL).

Since two of the top mortality risk indicators – blood urea nitrogen level and serum creatinine – involve renal or kidney function, this finding emphasizes the importance of further study in this area.

This simple approach is a first in the treatment of acute heart failure, providing a quick way for clinicians to assess mortality risk upon hospital admission and decide on a treatment strategy without potentially dangerous delays.

Evaluation tool ready for clinical use

Researchers demonstrated that this risk tool, using only three variables, was able to dramatically distinguish between low-, intermediate-, and high-risk heart failure patients. The overall mortality risk for patients hospitalized with acute heart failure in this study was 4.1 percent. The model determined mortality risk levels starting from low risk at 2.1 percent up to 21.9 percent for patients with the highest mortality risk.

The new risk evaluation tool is now ready for clinical use and can be applied at hospitals across the country. By allowing physicians to rapidly assess in-hospital risk, this risk score has the potential to save time and money by eliminating additional testing done for prognostic purposes.

JAMA article

Fonarow GC, et al: Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis.
JAMA 293(5)572-80 February 2, 2005.

UCLA lead investigator

Gregg C. Fonarow, M.D.
Director, Ahmanson-UCLA Cardiomyopathy Center
Eliot Corday Chair in Cardiovascular Medicine and Science
Professor of Cardiology
David Geffen School of Medicine at UCLA

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