Clinical Outcomes When Utilizing Sacubitril-Valsartan Vs. ACEi/ARB In Patients With HF And Ejection Fractions Spanning From Reduced To Preserved - A Retrospective, Parallel, Multi-Group Study
HFSA ePoster Library. Albert N. 09/10/21; 343448; 216
Dr. Nancy Albert
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Abstract
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Introduction: Heart failure (HF) remains one of the leading causes of mortality, especially after patients were admitted for acute decompensated HF (ADHF). However, risk scores for long-term risk prediction after developing ADHF using common clinical parameters have not been well studied. Recently, the BAN-ADHF risk score was developed using machine learning-based variable importance metrics in a cohort of patients with ADHF to predict diuretic resistance. However, its ability to predict long-term outcomes in real world cohort of patients with ADHF has not been established.
Hypothesis: We hypothesized that the BAN-ADHF risk score will accurately stratify risk of long-term all-cause mortality in patients with ADHF.
Methods: Electronic medical records of 965 patients admitted with ADHF at the Cleveland Clinic were reviewed. We excluded 70 patients with missing data for calculating the risk score for a final analysis cohort of 895 patients. The BAN-ADHF risk score were calculated using clinical variables and weighted scores, which included baseline BUN, Cr, NT-proBNP, diastolic blood pressure (DBP), age, history of diabetes, atrial fibrillation, and years of HF. Participants were categorized into quintile groups of BAN-ADHF scores (≤5, 6-7, 8, 9-11, and ≥12). Kaplan Meier and Cox proportional hazard models were used to evaluate the association between the BAN-ADHF score groups and mortality with differences determined using the log-rank test.
Results: Mean age was 69.8±15.6 years, 49.9% were men, 71.6% had AF, 58.4% had diabetes, and 85% had CKD. Median (IQR) was 71 (62-80) mmHg for DBP, 21 (15-10) mg/dL for BUN, 1.10 (0.87-1.50) mg/dL for Cr, and 2,856 (1,042.5-7,025.5) pg/mL for NT-proBNP. During median follow up of 1,467 days, 467 (52.2%) patients died. A step-wise increase in all-cause mortality was observed across increasing BAN-ADHF quintiles (Figure, log-rank p<0.001). Compared to Quintile 1, participants with BAN-ADHF scores in Quintile 5 had a 192% higher risk of all-cause mortality (HR 2.92, 95% CI 2.18-3.92, p<0.001).
Conclusions: Higher BAN-ADHF risk scores are significantly associated with an increased risk of long-term all-cause mortality in patients with ADHF.
Hypothesis: We hypothesized that the BAN-ADHF risk score will accurately stratify risk of long-term all-cause mortality in patients with ADHF.
Methods: Electronic medical records of 965 patients admitted with ADHF at the Cleveland Clinic were reviewed. We excluded 70 patients with missing data for calculating the risk score for a final analysis cohort of 895 patients. The BAN-ADHF risk score were calculated using clinical variables and weighted scores, which included baseline BUN, Cr, NT-proBNP, diastolic blood pressure (DBP), age, history of diabetes, atrial fibrillation, and years of HF. Participants were categorized into quintile groups of BAN-ADHF scores (≤5, 6-7, 8, 9-11, and ≥12). Kaplan Meier and Cox proportional hazard models were used to evaluate the association between the BAN-ADHF score groups and mortality with differences determined using the log-rank test.
Results: Mean age was 69.8±15.6 years, 49.9% were men, 71.6% had AF, 58.4% had diabetes, and 85% had CKD. Median (IQR) was 71 (62-80) mmHg for DBP, 21 (15-10) mg/dL for BUN, 1.10 (0.87-1.50) mg/dL for Cr, and 2,856 (1,042.5-7,025.5) pg/mL for NT-proBNP. During median follow up of 1,467 days, 467 (52.2%) patients died. A step-wise increase in all-cause mortality was observed across increasing BAN-ADHF quintiles (Figure, log-rank p<0.001). Compared to Quintile 1, participants with BAN-ADHF scores in Quintile 5 had a 192% higher risk of all-cause mortality (HR 2.92, 95% CI 2.18-3.92, p<0.001).
Conclusions: Higher BAN-ADHF risk scores are significantly associated with an increased risk of long-term all-cause mortality in patients with ADHF.
Introduction: Heart failure (HF) remains one of the leading causes of mortality, especially after patients were admitted for acute decompensated HF (ADHF). However, risk scores for long-term risk prediction after developing ADHF using common clinical parameters have not been well studied. Recently, the BAN-ADHF risk score was developed using machine learning-based variable importance metrics in a cohort of patients with ADHF to predict diuretic resistance. However, its ability to predict long-term outcomes in real world cohort of patients with ADHF has not been established.
Hypothesis: We hypothesized that the BAN-ADHF risk score will accurately stratify risk of long-term all-cause mortality in patients with ADHF.
Methods: Electronic medical records of 965 patients admitted with ADHF at the Cleveland Clinic were reviewed. We excluded 70 patients with missing data for calculating the risk score for a final analysis cohort of 895 patients. The BAN-ADHF risk score were calculated using clinical variables and weighted scores, which included baseline BUN, Cr, NT-proBNP, diastolic blood pressure (DBP), age, history of diabetes, atrial fibrillation, and years of HF. Participants were categorized into quintile groups of BAN-ADHF scores (≤5, 6-7, 8, 9-11, and ≥12). Kaplan Meier and Cox proportional hazard models were used to evaluate the association between the BAN-ADHF score groups and mortality with differences determined using the log-rank test.
Results: Mean age was 69.8±15.6 years, 49.9% were men, 71.6% had AF, 58.4% had diabetes, and 85% had CKD. Median (IQR) was 71 (62-80) mmHg for DBP, 21 (15-10) mg/dL for BUN, 1.10 (0.87-1.50) mg/dL for Cr, and 2,856 (1,042.5-7,025.5) pg/mL for NT-proBNP. During median follow up of 1,467 days, 467 (52.2%) patients died. A step-wise increase in all-cause mortality was observed across increasing BAN-ADHF quintiles (Figure, log-rank p<0.001). Compared to Quintile 1, participants with BAN-ADHF scores in Quintile 5 had a 192% higher risk of all-cause mortality (HR 2.92, 95% CI 2.18-3.92, p<0.001).
Conclusions: Higher BAN-ADHF risk scores are significantly associated with an increased risk of long-term all-cause mortality in patients with ADHF.
Hypothesis: We hypothesized that the BAN-ADHF risk score will accurately stratify risk of long-term all-cause mortality in patients with ADHF.
Methods: Electronic medical records of 965 patients admitted with ADHF at the Cleveland Clinic were reviewed. We excluded 70 patients with missing data for calculating the risk score for a final analysis cohort of 895 patients. The BAN-ADHF risk score were calculated using clinical variables and weighted scores, which included baseline BUN, Cr, NT-proBNP, diastolic blood pressure (DBP), age, history of diabetes, atrial fibrillation, and years of HF. Participants were categorized into quintile groups of BAN-ADHF scores (≤5, 6-7, 8, 9-11, and ≥12). Kaplan Meier and Cox proportional hazard models were used to evaluate the association between the BAN-ADHF score groups and mortality with differences determined using the log-rank test.
Results: Mean age was 69.8±15.6 years, 49.9% were men, 71.6% had AF, 58.4% had diabetes, and 85% had CKD. Median (IQR) was 71 (62-80) mmHg for DBP, 21 (15-10) mg/dL for BUN, 1.10 (0.87-1.50) mg/dL for Cr, and 2,856 (1,042.5-7,025.5) pg/mL for NT-proBNP. During median follow up of 1,467 days, 467 (52.2%) patients died. A step-wise increase in all-cause mortality was observed across increasing BAN-ADHF quintiles (Figure, log-rank p<0.001). Compared to Quintile 1, participants with BAN-ADHF scores in Quintile 5 had a 192% higher risk of all-cause mortality (HR 2.92, 95% CI 2.18-3.92, p<0.001).
Conclusions: Higher BAN-ADHF risk scores are significantly associated with an increased risk of long-term all-cause mortality in patients with ADHF.
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