Beth A Davison1,2, Stefanie Senger1, Iziah E Sama3, Gary G Koch4, Alexandre Mebazaa5, Kenneth Dickstein6, Nilesh J Samani7, Marco Metra8, Stefan D Anker9, John G Cleland10, Leong L Ng11, Ify R Mordi11, Faiez Zannad12, Gerasimos S Filippatos13, Hans L Hillege3, Piotr Ponikowski14, Dirk J van Veldhuisen3, Chim C Lang11, Peter van der Meer3, Julio Núñez15, Antoni Bayés-Genís16, Christopher Edwards1, Adriaan A Voors3, Gad Cotter1,2. 1. Momentum Research, Inc., Durham, NC, USA. 2. Inserm U-942 MASCOT, Paris, France. 3. University of Groningen, Groningen, The Netherlands. 4. University of North Carolina, Chapel Hill, NC, USA. 5. Université de Paris, Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, Paris, France. 6. University of Bergen, Stavanger University Hospital, Bergen, Norway. 7. NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK. 8. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy. 9. Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany. 10. National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK. 11. Division of Molecular and Clinical Medicine, Medical Research Institute, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK. 12. Inserm CIC-P 1433, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France. 13. National and Kapodistrian University of Athens, School of Medicine, Athens, Greece. 14. Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland. 15. Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain. 16. Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Abstract
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.
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.
Authors: Nicolas Girerd; John Cleland; Stefan D Anker; William Byra; Carolyn S P Lam; David Lapolice; Mandeep R Mehra; Dirk J van Veldhuisen; Emmanuel Bresso; Zohra Lamiral; Barry Greenberg; Faiez Zannad Journal: Sci Rep Date: 2022-05-20 Impact factor: 4.996
Authors: Matteo Pagnesi; Marianna Adamo; Iziah E Sama; Stefan D Anker; John G Cleland; Kenneth Dickstein; Gerasimos S Filippatos; Chim C Lang; Leong L Ng; Piotr Ponikowski; Alice Ravera; Nilesh J Samani; Faiez Zannad; Dirk J van Veldhuisen; Adriaan A Voors; Marco Metra Journal: Eur J Heart Fail Date: 2021-08-01 Impact factor: 17.349