The Modified Rajan's Heart Failure Risk Score Predicts All-cause Mortality in Patients Hospitalized for Heart Failure with Reduced Ejection Fraction: a Retrospective Cohort Study

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2024 Apr 5

PMID 38576988

Authors

Rajesh Rajan

Jeremy Man Ho Hui

Mohammad A Al Jarallah

Gary Tse

Jeffrey Shi Kai Chan

Danish Iltaf Satti

Chloe Tsz Ching Hui

Yuxi Sun

Yan Hiu Athena Lee

Ying Liu

Govindan Vijayaraghavan

Ibrahim Al-Zakwani

Laura AlObaid

Affiliations

Soon will be listed here.

Abstract

Background: The dimensionless Rajan's heart failure (R-hf) risk score was proposed to predict all-cause mortality in patients hospitalized with chronic heart failure (HF) and reduced ejection fraction (EF) (HFrEF).

Purpose: To examine the association between the modified R-hf risk score and all-cause mortality in patients with HFrEF.

Methods: Retrospective cohort study included adults hospitalized with HFrEF, as defined by clinical symptoms of HF with biplane EF less than 40% on transthoracic echocardiography, at a tertiary centre in Dalian, China, between 1 November 2015, and 31 October 2019. All patients were followed up until 31 October 2020. A modified R-hf risk score was calculated by substituting brain natriuretic peptide (BNP) for N-terminal prohormone of BNP (NT-proBNP) using EF× estimated glomerular filtration rate (eGFR)× haemoglobin (Hb))/BNP. The patients were stratified into tertiles according to the R-hf risk score. The measured outcome was all-cause mortality. The score performance was assessed using C-statistics.

Results: A total of 840 patients were analyzed (70.2% males; mean age, 64±14 years; median (interquartile range) follow-up 37.0 (27.8) months). A lower modified R-hf risk score predicted a higher risk of all-cause mortality, independent of sex and age [1st tertile vs. 3rd tertile: adjusted hazard ratio (aHR), 3.46; 95% CI: 2.11-5.67; <0.001]. Multivariate Cox regression analysis indicated that a lower modified R-hf risk score was associated with increased cumulative all-cause mortality [univariate: (1st tertile vs. 3rd tertile: aHR, 3.45; 95% CI: 2.11-5.65; <0.001) and multivariate: (1st tertile vs. 3rd tertile: aHR 2.21, 95% CI: 1.29-3.79; =0.004)]. The performance of the model, as reported by -statistic was 0.67 (95% CI: 0.62-0.72).

Conclusion: The modified R-hf risk score predicted all-cause mortality in patients hospitalized with HFrEF. Further validation of the modified R-hf risk score in other cohorts of patients with HFrEF is needed before clinical application.

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