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Applicability of GWTG Score to Heart Failure Patients in South India
Background The get with the guidelines (GWTG) risk score was developed to predict in-hospital mortality in acute heart failure patients. We aimed to clarify the prognostic impacts of the GWTG risk score in the south Indian heart failure patients admitted to intensive cardiac care unit (ICCU) in our hospital.
Aim Our primary aim was to see the applicability of predicted GWTG risk score of heart failure in the south Indian heart failure patients admitted to intensive cardiac care unit (ICCU) of our hospital. Our secondary aim was to see the event rates and correlate predicted GWTG risk score of heart failure with in-hospital complications.
Materials and Methods We included all the patients admitted to ICCU with the diagnosis of either ischemic or dilated cardiomyopathy over 6 months (January 2018 to June 2018). Indication for admission was either symptomatic heart failure (HF) or to evaluate cause for heart failure. We recorded the demographic and clinical parameters along with the ECG, 2D echo features, and relevant laboratory investigations. The GWTG risk score was based on seven parameters. Race, age, systolic blood pressure, heart rate, blood urea nitrogen (BUN) level, sodium concentration, and presence of chronic obstructive pulmonary disease (COPD) were used to predict in-hospital all-cause mortality, and in-hospital complications were noted.
Results Out of 130 patients, 97 patients fulfilled the inclusion criteria. Out of them, 65 were males, with most of the patients between 40 to 80 years of age. Half the patients were diabetic and had abnormal electrocardiogram (ECG), and more than half were hypertensive, had clinically left ventricular failure (LVF) and diagnosed with ischemic cardiomyopathy (ICMP). Very few were smokers, and < 30% were alcoholics, had abnormal liver function tests (LFT) and diagnosed with dilated cardiomyopathy (DCMP). Patients were divided into ICMP and DCMP patients, and all the variables were compared. Low systolic blood pressure (BP), abnormal ECG and the mean of GWTG score were greater in 22 patients afflicted with DCMP. However, abnormal renal functions with anemia and more NT-pro-brain natriuretic peptide (NT-proBNP) elevations were observed in ICMP HF patients. Out of 97 patients 70% patients had GTWG score of 34 to 50. There were no patients with score > 58 in our study. Eighteen patients showed in-hospital complications. Five patients died with mean GWTG score 45.00, and they experienced cardiogenic shock with tachycardia and severe LV dysfunction (ejection fraction [EF] < 15%), renal failure, hyponatremia, NT-proBNP levels > 25,000 pg/dl and hepatic derangement at admission. A total of 92 patients were discharged with 39.02 mean GWTG score. There was a significant difference between the mean GWTG scores of patients in their final status (discharged/death) (p = 0.040). Also, patients with in-hospital complications had higher GWTG values (on an average 7 scores higher) than without complications (p = 0.000).
Conclusions GWTG scores were able to predict (with statistical significance) the true end results for both complications during hospitalization and final discharge/death in hospitalized Indian HF patients. Higher GWTG Scores were an indication of complications or death (39 for complications and 45 for death seems to be the possible average values).
14 April 2021 (online)
© 2021. Women in Cardiology and Related Sciences. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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- 1 Ambrosy AP, Fonarow GC, Butler J. et al. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63: 1123-1133
- 2 Peterson PN, Rumsfeld JS, Liang L. et al. American Heart Association Get With the Guidelines–Heart Failure Program. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association Get With the Guidelines program. Circ Cardiovasc Qual Outcomes 2010; 3: 25-32
- 3 Pocock SJ, Wang D, Pfeffer MA. et al. CHARM Investigators. on behalf of the Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J 2006; 27: 65-75
- 4 Suzuki S, Yoshihisa A, Sato Y. et al. Clinical significance of get with the guidelines–heart failure risk score in patients with chronic heart failure after hospitalization. J Am Heart Assoc 2018; 7: e008316
- 5 Fonarow GC, Adams Jr KF, Abraham WT, Yancy CW, Boscardin WJ. For the ADHERE Scientific Advisory Committee SGaI. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 2005; 293: 572-580
- 6 Abraham WT, Fonarow GC, Albert NM. et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008; 52: 347-356
- 7 O’Connor CM, Mentz RJ, Cotter G, Metra M, Cleland JG, Davison BA. The PROTECT In-Hospital Risk Model: 7-day outcome in patients hospitalized with acute heart failure and renal dysfunction. Heart Fail 2012; 14 (06) 605-612
- 8 Felker GM, Leimberger JD, Califf RM. et al. Risk stratification after hospitalization for decompensated heart failure. J Card Fail 2004; 10: 460-466
- 9 Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003; 290: 2581-2587
- 10 Levy WC, Mozaffarian D, Linker DT. et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 2006; 113: 1424-1433
- 11 Hauptman PJ, Swindle J, Hussain Z, Biener L, Burroughs TE. Physician attitudes toward end-stage heart failure: a national survey. Am J Med 2008; 121: 127-135
- 12 Lee DS, Tu JV, Juurlink DN. et al. Risk-treatment mismatch in the pharmacotherapy of heart failure. JAMA 2005; 294: 1240-1247