Risk stratification in heart failure decompensation in the community: HEFESTOS score

• Published in: ESC Heart Failure 2022-02, Vol.9 (1), p.606-613
• Main Authors: Verdu‐Rotellar, José‐María, Abellana, Rosa, Vaillant‐Roussel, Helene, Gril Jevsek, Lea, Assenova, Radost, Kasuba Lazic, Djurdjica, Torsza, Peter, Glynn, Liam George, Lingner, Heidrun, Demurtas, Jacopo, Thulesius, Hans, Muñoz, Miguel Angel
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Blood pressure; Cardiac and Cardiovascular Systems; Cardiovascular disease; Chronic obstructive pulmonary disease; Clinical Medicine; Comorbidity; Decompensation; Dyspnea; Edema; Ejection fraction; Emergency medical care; Europe - epidemiology; Female; Heart failure; Heart Failure - epidemiology; Heart Failure - mortality; Heart Failure - therapy; Heart rate; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Humans; Kardiologi; Klinisk medicin; Male; Medical and Health Sciences; Medical records; Medicin; Medicin och hälsovetenskap; Medicine; Models, Cardiovascular; Mortality; Original; Outpatient care facilities; Patients; Primary care; Prognosis; Residence Characteristics - statistics & numerical data; Risk Assessment - methods; Risk stratification; Severity of Illness Index; Stroke Volume; Ventricular Function, Left
• ISSN: 2055-5822; 2055-5822
• DOI: 10.1002/ehf2.13707

Aims Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings. Methods and results HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the derivation cohort and 58.8% in the validation one (P = 0.004). Mortality/hospitalization during the first 30 days after a decompensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles (OR: 2.35; P = 0.01), New York Heart Association functional class III/IV (OR: 2.11; P = 0.001), oxygen saturation ≤ 90% (OR: 4.98; P  100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45; P