Score devised to identify patients with HF, CRT-D at risk for poor outcomes

Researchers have devised a score to identify high-risk patients with HF and a cardiac resynchronization therapy defibrillator who could benefit from more intensive monitoring or greater circulatory support.

The score combines clinical and biomarker data to identify patients at risk for HF progression and death. According to the report in Heart Rhythm, patients with dyssynchronous systolic HF can have reduced morbidity and mortality with CRT-D, but vary in their progression to a worsened HF state.

Victor Nauffal, MD, from the department of medicine, Johns Hopkins Medical Institutes, and colleagues analyzed 305 patients with dyssynchronous systolic HF and CRT-D from the Prospective Observational Study of Implantable Cardioverter Defibrillators.

Patients were followed for all-cause mortality, left ventricular assist device implant or heart transplant at 1 year and 3 years, and collected serum biomarkers, ECG variables and clinical variables at implant. The researchers performed multivariable analysis on those data to construct a model.

Of the 305 patients, 53 died or required LVAD implant or heart transplant during the study period. The researchers identified five independent predictors of those outcomes:

• high-sensitivity C-reactive protein > 9.42 ng/L (HR = 2.5; 95% CI, 1.4-4.5);
• NYHA class III or IV HF (HR = 2.3; 95% CI, 1.2-4.5);
• creatinine > 1.2 mg/dL (HR = 2.7; 95% CI, 1.4-5.1);
• red blood cell count < 4.3 x 10⁶/µL (HR = 2.4; 95% CI, 1.3-4.7); and
• cardiac troponin T > 28 ng/L (HR = 2.7; 95% CI, 1.4-5.2).

Each of those five predictors was assigned one point to devise the HF-CRT score, and patients were stratified by a score of 0 or 1, 2 or 3, or 4 or 5.

The cumulative 3-year event-free survival rate of those with a score of 4 or 5 was 35.2%, compared with 96.8% for those with a score of 0 or 1 and 79.7% for those with a score of 2 or 3 (P < .001). In the highest-risk group, approximately half the events occurred within 1 year of implant, according to the results.

The C-statistic of the 3-year multivariable model was 0.81 (95% CI, 0.76-0.86).

“The HF-CRT score is focused on outcome-based risk stratification in a way that may better inform clinicians on the optimal management of these patients,” Nauffal and colleagues wrote. “While further validation in larger cohorts will be needed, this information can potentially guide decision making in individuals with advanced dyssynchronous HF when there is clinical equipoise between CRT-D implantation and use of more advanced circulatory support interventions.” – by Erik Swain

Disclosure: Nauffal reports no relevant financial disclosures. See the full study for a list of all other researchers’ relevant financial disclosures.