PMID- 24179162
OWN - NLM
STAT- MEDLINE
DCOM- 20140218
LR  - 20140101
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 100
IP  - 2
DP  - 2014 Jan
TI  - 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: ELAN-HF Score.
PG  - 115-25
LID - 10.1136/heartjnl-2013-303632 [doi]
AB  - 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.
FAU - Salah, Khibar
AU  - Salah K
AD  - Heart failure Research Center & Department of Cardiology, Academic Medical 
      Center, University of Amsterdam, , Amsterdam, The Netherlands.
FAU - Kok, Wouter E
AU  - Kok WE
FAU - Eurlings, Luc W
AU  - Eurlings LW
FAU - Bettencourt, Paulo
AU  - Bettencourt P
FAU - Pimenta, Joana M
AU  - Pimenta JM
FAU - Metra, Marco
AU  - Metra M
FAU - Bayes-Genis, Antoni
AU  - Bayes-Genis A
FAU - Verdiani, Valerio
AU  - Verdiani V
FAU - Bettari, Luca
AU  - Bettari L
FAU - Lazzarini, Valentina
AU  - Lazzarini V
FAU - Damman, Peter
AU  - Damman P
FAU - Tijssen, Jan G
AU  - Tijssen JG
FAU - Pinto, Yigal M
AU  - Pinto YM
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
DEP - 20131031
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Peptide Fragments)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Disease Progression
MH  - Female
MH  - Heart Failure/blood/*diagnosis/mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*blood
MH  - Patient Discharge
MH  - Patient Readmission/statistics & numerical data
MH  - Peptide Fragments/*blood
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Assessment/*methods
OTO - NOTNLM
OT  - Heart Failure
EDAT- 2013/11/02 06:00
MHDA- 2014/02/19 06:00
CRDT- 2013/11/02 06:00
PHST- 2013/11/02 06:00 [entrez]
PHST- 2013/11/02 06:00 [pubmed]
PHST- 2014/02/19 06:00 [medline]
AID - heartjnl-2013-303632 [pii]
AID - 10.1136/heartjnl-2013-303632 [doi]
PST - ppublish
SO  - Heart. 2014 Jan;100(2):115-25. doi: 10.1136/heartjnl-2013-303632. Epub 2013 Oct 
      31.