Is acute heart failure a distinctive disorder? An analysis from BIOSTAT-CHF
Por:
Davison, BA, Senger, S, Sama, IE, Koch, GG, Mebazaa, A, Dickstein, K, Samani, NJ, Metra, M, Anker, SD, Cleland, JG, Ng, LL, Mordi, IR, Zannad, F, Filippatos, GS, Hillege, HL, Ponikowski, P, van Veldhuisen, DJ, Lang, CC, van der Meer, P, Nunez, J, Bayes-Genis, A, Edwards, C, Voors, AA and Cotter, G
Publicada:
1 ene 2021
Ahead of Print:
1 ene 2021
Resumen:
Aims This retrospective analysis sought to identify markers that might distinguish between acute heart failure (HF) and worsening HF in chronic outpatients.
Methods and results The BIOSTAT-CHF index cohort included 2516 patients with new or worsening HF symptoms: 1694 enrolled as inpatients (acute HF) and 822 as outpatients (worsening HF in chronic outpatients). A validation cohort included 935 inpatients and 803 outpatients. Multivariable models were developed in the index cohort using clinical characteristics, routine laboratory values, and proteomics data to examine which factors predict adverse outcomes in both conditions and to determine which factors differ between acute HF and worsening HF in chronic outpatients, validated in the validation cohort. Patients with acute HF had substantially higher morbidity and mortality (6-month mortality was 12.3% for acute HF and 4.7% for worsening HF in chronic outpatients). Multivariable models predicting 180-day mortality and 180-day HF readmission differed substantially between acute HF and worsening HF in chronic outpatients. Carbohydrate antigen 125 was the strongest single biomarker to distinguish acute HF from worsening HF in chronic outpatients, but only yielded a C-index of 0.71. A model including multiple biomarkers and clinical variables achieved a high degree of discrimination with a C-index of 0.913 in the index cohort and 0.901 in the validation cohort.
Conclusions This study identifies different characteristics and predictors of outcome in acute HF patients as compared to outpatients with chronic HF developing worsening HF. The markers identified may be useful in better diagnosing acute HF and may become targets for treatment development.
Filiaciones:
Davison, BA:
Momentum Res Inc, 807 East Main St,Suite 6-050, Durham, NC 27701 USA
Inserm U 942 MASCOT, Paris, France
Senger, S:
Momentum Res Inc, 807 East Main St,Suite 6-050, Durham, NC 27701 USA
Sama, IE:
Univ Groningen, Groningen, Netherlands
Koch, GG:
Univ N Carolina, Chapel Hill, NC 27515 USA
Mebazaa, A:
Univ Paris, Hop Univ St Louis Lariboisiere, Dept Anesthesia Burn & Crit Care, Paris, France
Dickstein, K:
Univ Bergen, Stavanger Univ Hosp, Bergen, Norway
Samani, NJ:
Glenfield Hosp, NIHR Leicester Biomed Res Ctr, Leicester, Leics, England
Metra, M:
Univ Brescia, Inst Cardiol, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, Brescia, Italy
Anker, SD:
Charite Univ Med Berlin, Dept Cardiol CVK, Berlin, Germany
Charite Univ Med Berlin, Berlin Inst Hlth Ctr Regenerat Therapies BCRT, Berlin, Germany
Charite Univ Med Berlin, German Ctr Cardiovasc Res DZHK Partner Site Berli, Berlin, Germany
Cleland, JG:
Imperial Coll, Natl Heart & Lung Inst, Royal Brompton Hosp, London, England
Imperial Coll, Natl Heart & Lung Inst, Harefield Hosp, London, England
Ng, LL:
Univ Dundee, Ninewells Hosp & Med Sch, Med Res Inst, Div Mol & Clin Med, Dundee, Scotland
Mordi, IR:
Univ Dundee, Ninewells Hosp & Med Sch, Med Res Inst, Div Mol & Clin Med, Dundee, Scotland
Zannad, F:
Univ Lorraine, Inserm CIC P 1433, CHRU Nancy, FCRIN INI CRCT, Nancy, France
Filippatos, GS:
Natl & Kapodistrian Univ Athens, Sch Med, Athens, Greece
Hillege, HL:
Univ Groningen, Groningen, Netherlands
Ponikowski, P:
Wroclaw Med Univ, Dept Heart Dis, Wroclaw, Poland
van Veldhuisen, DJ:
Univ Groningen, Groningen, Netherlands
Lang, CC:
Univ Dundee, Ninewells Hosp & Med Sch, Med Res Inst, Div Mol & Clin Med, Dundee, Scotland
van der Meer, P:
Univ Groningen, Groningen, Netherlands
Nunez, J:
Univ Valencia, Hosp Clin Univ Valencia, Dept Cardiol, INCLIVA, Valencia, Spain
:
Autonomous Univ Barcelona, Cardiol Dept, Hosp Univ Germans Trias & Pujol, Dept Med, Barcelona, Spain
Autonomous Univ Barcelona, Heart Failure Unit, Hosp Univ Germans Trias & Pujol, Dept Med, Barcelona, Spain
Edwards, C:
Momentum Res Inc, 807 East Main St,Suite 6-050, Durham, NC 27701 USA
Voors, AA:
Univ Groningen, Groningen, Netherlands
Cotter, G:
Momentum Res Inc, 807 East Main St,Suite 6-050, Durham, NC 27701 USA
Inserm U 942 MASCOT, Paris, France
Green Published, Green Submitted, Green Accepted, Bronze
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