• Domenico Scrutinio, Enrico Ammirati, Pietro Guida, Andrea Passantino, Rosa Raimondo, Valentina Guida, Simona Sarzi Braga, Paolo Canova, Filippo Mastropasqua, Maria Frigerio, Rocco Lagioia, and Fabrizio Oliva.
• Division of Cardiology and Cardiac Rehabilitation, "S. Maugeri" Foundation, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Institute of Cassano Murge. Bari. Electronic address: domenico.scrutinio@fsm.it.
• J. Heart Lung Transplant. 2014 Apr 1; 33 (4): 404-11.

BackgroundThe acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF).MethodsWe studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ≤ 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive.ResultsDuring follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ≤ 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (≤6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ≤ 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip.ConclusionsOur data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF.Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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