GWTG-HF score as a strong predictor of cardiovascular mortality after hospitalization

Background

Heart failure (HF) is a common disease with high morbidity and mortality. Several risk scores predict all-cause mortality, sudden cardiac death, and cardiovascular events in HF patients. The Get With the Guidelines – Heart Failure (GWTG-HF) risk score predicts in-hospital mortality in acute HF, using simple variables.

Purpose

To evaluate the prognostic impacts of the GWTG-HF risk score in patients with HF after discharge.

Methods

Retrospective single-center cohort study of adult patients hospitalized in 2022 with a diagnosis of acute HF. The GWTG-HF score was calculated using 7 predetermined variables, with all variable values obtained at admission.

Results

A total of 255 patients (68.2% male; median age of 73 years) were followed for a median of 463 days. The median GWTG-HF score was 44 (IQR, 44.7–47.2), with 20.8% scoring ≥55 points. Higher scores were significantly associated with older age (p<0.001), chronic kidney disease (p=0.017), chronic decompensated HF (p=0.034), right ventricular dysfunction (p=0.009) and higher NT-proBNP levels (p < 0.001).

In-hospital mortality was 3.9%, higher among patients with higher scores (50.0% vs. 19.6%; p=0.020), as did cardiovascular (CV) mortality (70.0% vs. 16.6%; p<0.001) and all-cause mortality (40.9% vs. 18.9%; p=0.015). Logistic regression confirmed independent associations of higher scores with in-hospital mortality (OR 1.063; 95% CI 1.005–1.125; p=0.032) and CV mortality (OR 1.106; 95% CI 1.056–1.158; p<0.001). ROC curve analysis showed moderate discrimination for in-hospital mortality (AUC 0.700; p=0.009) and good predictive accuracy for in-hospital CV mortality (AUC 0.811; p<0.001).

Post-discharge CV mortality was 5.5%, overall CV mortality was 7.8%. Patients who died post-discharge had higher GWTG-HF scores and NT-proBNP levels during hospitalization (p<0.001), whereas admission LVEF was not predictive (p=0.119). The optimal GWTG-HF cutoff of 54.5 predicted post-discharge cardiovascular mortality with 78.6% sensitivity and 82.6% specificity (AUC 0.845; 95% CI 0.755–0.936). Notably, the post-discharge CV mortality curve showed the best ROC performance (AUC 0.845; 95% CI 0.755–0.936), compared with in-hospital and overall CV mortality.

Conclusions

Originally developed to predict in-hospital mortality, the GWTG-HF score also provides prognostic value after discharge, extending into the chronic phase, as demonstrated in our cohort.