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PREDICTING OUTCOMES USING THE HEART FAILURE SURVIVAL SCORE IN ADULTS WITH CONGENITAL HEART DISEASE
E507 JACC March 12, 2013 Volume 61, Issue 10
Congenital Cardiology Solutions Predicting Outcomes Using the Heart Failure Survival Score in Adults with Congenital Heart Disease Oral Contributions West, Room 3005 Sunday, March 10, 2013, 11:30 a.m.-11:45 a.m.
Session Title: Congenital Cardiology Solutions: Adult Abstract Category: 12. Congenital Cardiology Solutions: Adult Presentation Number: 924-6 Authors: Elaine Y. Lin, Hillel W. Cohen, Jacob Johnson, Ada Stefanescu, Ami B. Bhatt, George K. Lui, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Background: Adults with congenital heart disease (CHD) face increased risk for morbidity and mortality as they age, but few prognostic models exist. This study aims to assess whether the Heart Failure Survival Score (HFSS) which risk stratifies patients for heart transplantation predicts outcomes in adults with CHD. Methods: This retrospective study identified 146 of 407 patients with moderate or complex CHD who underwent cardiopulmonary exercise test and had all the HFSS parameters at Montefiore Medical Center in Bronx, NY and Massachusetts General Hospital in Boston, MA from 2009 and 2012. HFSS components (coronary disease, interventricular conduction delay, systemic ventricular ejection fraction (EF), resting pulse, sodium, mean arterial pressure, peak VO2) were collected. Risk strata are defined as low (>8.10), medium (7.2-8.09), and high risk (≤7.19). Death, transplant or ventricular assist device (VAD), arrhythmias, non-elective cardiovascular (CV) hospitalizations, and the composite were studied. HFSS was calculated based on published algorithms. Associations between HFSS and each outcome were calculated. Results: The cohort had a mean age of 34 years, peak VO2 of 21.5 mL/kg/min, and HFSS of 10.4. Follow-up averaged 166 days for death. There were 4 deaths, no transplants or VADs, 55 arrhythmias, 104 CV hospitalizations (in 40 patients), and 73 composites. One patient was medium risk by HFSS; the rest were low risk. Lower mean HFSS was observed for those with versus those without outcome: death (9.5 ± 0.95 vs. 10.4 ± 0.83, p = 0.04), arrhythmias (10.1 ± 0.87 vs. 10.5 ± 0.79, p = 0.003), CV hospitalizations (10.1 ± 0.74 vs. 10.5 ± 0.86, p = 0.006), and composites (10.1 ± 0.83 vs. 10.6 ± 0.78, p < 0.001). All outcomes occurred in low risk patients so that sensitivity and positive predictive value of medium risk was 0 for each outcome. Conclusion: Although the HFSS was significantly associated with outcomes, medium and low risk strata failed to further risk stratify, making this model inadequate for prognosticating CHD patients, whose heterogeneous pathophysiology differs from that of the general heart failure population. Further studies are warranted to provide accurate prognosis in adults with CHD.
Congenital Cardiology Solutions Predicting Outcomes Using the Heart Failure Survival Score in Adults with Congenital Heart Disease Oral Contributions West, Room 3005 Sunday, March 10, 2013, 11:30 a.m.-11:45 a.m.
Session Title: Congenital Cardiology Solutions: Adult Abstract Category: 12. Congenital Cardiology Solutions: Adult Presentation Number: 924-6 Authors: Elaine Y. Lin, Hillel W. Cohen, Jacob Johnson, Ada Stefanescu, Ami B. Bhatt, George K. Lui, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA Background: Adults with congenital heart disease (CHD) face increased risk for morbidity and mortality as they age, but few prognostic models exist. This study aims to assess whether the Heart Failure Survival Score (HFSS) which risk stratifies patients for heart transplantation predicts outcomes in adults with CHD. Methods: This retrospective study identified 146 of 407 patients with moderate or complex CHD who underwent cardiopulmonary exercise test and had all the HFSS parameters at Montefiore Medical Center in Bronx, NY and Massachusetts General Hospital in Boston, MA from 2009 and 2012. HFSS components (coronary disease, interventricular conduction delay, systemic ventricular ejection fraction (EF), resting pulse, sodium, mean arterial pressure, peak VO2) were collected. Risk strata are defined as low (>8.10), medium (7.2-8.09), and high risk (≤7.19). Death, transplant or ventricular assist device (VAD), arrhythmias, non-elective cardiovascular (CV) hospitalizations, and the composite were studied. HFSS was calculated based on published algorithms. Associations between HFSS and each outcome were calculated. Results: The cohort had a mean age of 34 years, peak VO2 of 21.5 mL/kg/min, and HFSS of 10.4. Follow-up averaged 166 days for death. There were 4 deaths, no transplants or VADs, 55 arrhythmias, 104 CV hospitalizations (in 40 patients), and 73 composites. One patient was medium risk by HFSS; the rest were low risk. Lower mean HFSS was observed for those with versus those without outcome: death (9.5 ± 0.95 vs. 10.4 ± 0.83, p = 0.04), arrhythmias (10.1 ± 0.87 vs. 10.5 ± 0.79, p = 0.003), CV hospitalizations (10.1 ± 0.74 vs. 10.5 ± 0.86, p = 0.006), and composites (10.1 ± 0.83 vs. 10.6 ± 0.78, p < 0.001). All outcomes occurred in low risk patients so that sensitivity and positive predictive value of medium risk was 0 for each outcome. Conclusion: Although the HFSS was significantly associated with outcomes, medium and low risk strata failed to further risk stratify, making this model inadequate for prognosticating CHD patients, whose heterogeneous pathophysiology differs from that of the general heart failure population. Further studies are warranted to provide accurate prognosis in adults with CHD.