Physician judgment, existing criteria differ for identifying advanced HF

NATIONAL HARBOR, Md. — Identification of patients with stage D HF differed significantly when done according to physician judgment compared with the use of current criteria, researchers reported at the Heart Failure Society of America Annual Scientific Meeting.

The researchers evaluated 512 outpatients diagnosed with HF with reduced ejection fraction. The mean age of the cohort was 61 years (35.2% women). Ejection fraction was lower than 30% in 60% of patients, and ischemic heart disease was present in 67.2%. The researchers compared the number of patients identified as having stage D HF using the European Society of Cardiology Heart Failure Association criteria with the number identified by physician chart review. Outcomes during a median of 2.9 years of follow-up also were evaluated.

Alanna A. Morris

During a presentation, Alanna A. Morris, MD, assistant professor of medicine in the cardiology division at Emory University School of Medicine, said 450 patients were identified by clinicians as having stage C HF, and most patients classified in this manner were similarly identified using ESC guidelines.

According to physician assessment, 12.1% of patients had stage D HF. However, Morris said, approximately two-thirds of the patients classified as having stage D HF by physician review would have been classified as stage C under the ESC guidelines, with a crude agreement of 84.2% between the two approaches (kappa = 0.25).

During follow-up, 19 patients received mechanical circulatory support, eight underwent heart transplant and 76 patients died. The mortality rate was 28.6% among patients jointly identified by both methods as having stage D HF vs. 12.4% among those jointly identified as having stage C HF (HR = 2.43; 95% CI, 1.04-5.67). Among patients classified as stage D by physician review alone, the mortality rate was 31.7% (HR = 2.88; 95% CI, 1.57-5.29 vs. jointly identified stage C patients); among those identified as having stage D HF via ESC criteria alone, the mortality rate was 16.9% (HR = 1.2; 95% CI, 0.52-2.8).

“There was some discordance between physician [judgment] and ESC criteria,” Morris concluded. “We also found that physician judgment has stronger prognostic implications when thinking about risk for death and/or progressing to need for mechanical circulatory support or heart transplantation. Physician judgment … will be needed to re-evaluate the existing criteria for stage D HF.” – by Adam Taliercio

Reference:

Yazdani M, et al. Rapid-Fire Abstracts I. Presented at: Heart Failure Society of America Annual Scientific Meeting; Sept. 26-29, 2015; National Harbor, Md.

Disclosure: Morris reports no relevant financial disclosures.