Clinical Significance of Get With the Guidelines-Heart Failure Risk Score in Patients With Chronic Heart Failure After Hospitalization

Abstract

Background The Get With the Guidelines-Heart Failure ( GWTG - HF ) risk score was developed using American Heart Association GWTG - HF program data and predicts in-hospital mortality in patients with acute heart failure (HF). We aimed to clarify the prognostic impacts of the GWTG - HF risk score in patients with HF after discharge. Methods and Results We examined the GWTG - HF score in 1452 patients with HF, who were admitted to our hospital and discharged after treatment, by calculating 7 predetermined variables. We divided all subjects into 3 groups according to the GWTG - HF risk score (low, moderate, and high score groups). The plasma B-type natriuretic peptide level significantly increased with increasing GWTG - HF risk score severity (median values of B-type natriuretic peptide: 167.0 in low, 260.7 in moderate, and 418.2 pg/mL in high score groups). We followed up all subjects after discharge, and there were 347 (23.9%) all-cause deaths and 407 (28.0%) cardiac events in follow-up periods. A Kaplan-Meier survival curve demonstrated that event rates of all-cause death and cardiovascular events, including worsening HF and cardiac death, significantly increased with increasing GWTG - HF risk score severity in all subjects, and also in 749 patients with HF with preserved ejection fraction (ejection fraction ≥50%) and 703 patients with HF with reduced ejection fraction (ejection fraction <50%) patients. The multivariable Cox proportional hazard regression analysis demonstrated that the GWTG - HF risk score was one of the significant predictors of all-cause mortality and cardiac events (all-cause mortality: hazard ratio, 1.537, 95% confidence interval, 1.172-2.023; cardiac events: hazard ratio, 1.584, 95% confidence interval, 1.344-1.860, per 10-point increase of GWTG - HF score). Conclusions The GWTG - HF risk score is a useful multivariable score model for several years after hospitalization in patients with HF in a Japanese population.

Keywords: GWTG‐HF risk score; heart failure; heart failure with preserved ejection fraction; long‐term follow‐up; prognosis.

Figures

Figure 1

Patient flowchart of this study.

Figure 2

Kaplan‐Meier analyses for all‐cause deaths (A) and cardiovascular events, including worsening heart failure and cardiac deaths (B), among the 3 GWTG‐HF risk score groups. Numbers at risk of respective groups were described at the bottom of figures.

Figure 3

Area under the curves of receiver operating characteristics in the GWTG‐HF risk score and modified model (the GWTG‐HF risk score adding NYHA functional class, the presence of anemia, left ventricular ejection fraction, and plasma BNP level) for all‐cause deaths and cardiac events. BNP indicates B‐type natriuretic peptide; GWTG‐HF, Get With the Guidelines–Heart Failure; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association classification.

Figure 4

Kaplan‐Meier analyses for all‐cause deaths in patients with HFrEF and HFpEF among the 3 GWTG‐HF risk score groups. Numbers at risk of respective groups were described at the bottom of figures. GWTG‐HF indicates Get With the Guidelines–Heart Failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

Figure 5

Kaplan‐Meier analyses for cardiac events, including worsening heart failure and cardiac deaths, in patients with HFrEF and HFpEF among the 3 GWTG‐HF risk score groups. Numbers at risk of respective groups were described at the bottom of figures. GWTG‐HF, Get With the Guidelines–Heart Failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.