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document
Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure : a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function ( PROTECT ) Study . BACKGROUND Acute heart failure is a common reason for admission , and outcome is often poor . Improved prognostic risk stratification may assist in the design of future trials and in patient management . Using data from a large randomized trial , we explored the prognostic value of clinical variables , measured at hospital admission for acute heart failure , to determine whether a few selected variables were inferior to an extended data set . METHODS AND RESULTS The prognostic model included 37 clinical characteristics collected at baseline in PROTECT , a study comparing rolofylline and placebo in 2033 patients admitted with acute heart failure . Prespecified outcomes at 30 days were death or rehospitalization for any reason ; death or rehospitalization for cardiovascular or renal reasons ; and , at both 30 and 180 days , all-cause mortality . No variable had a c-index > 0.70 , and few had values > 0.60 ; c-indices were lower for composite outcomes than for mortality . Blood urea was generally the strongest single predictor . Eighteen variables contributed independent prognostic information , but a reduced model using only 8 items ( age , previous heart failure hospitalization , peripheral edema , systolic blood pressure , serum sodium , urea , creatinine , and albumin ) performed similarly . For prediction of all-cause mortality at 180 days , the model c-index using all variables was 0.72 and for the simplified model , also 0.72 . CONCLUSIONS A few simple clinical variables measured on admission in patients with acute heart failure predict a variety of adverse outcomes with accuracy similar to more complex models . However , predictive models were of only moderate accuracy , especially for outcomes that included nonfatal events . Better methods of risk stratification are required . CLINICAL TRIAL REGISTRATION URL : http : //www.clinicaltrials.gov . Unique identifiers : NCT00328692 and NCT00354458 .
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Intervention_Pharmacological
Selective A1 Adenosine Receptor Antagonist Rolofylline
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Intervention_Pharmacological
rolofylline
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Intervention_Control
placebo
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Outcome_Mortality
death
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Outcome_Other
rehospitalization for any reason
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Outcome_Mortality
death
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Outcome_Other
rehospitalization for cardiovascular or renal reasons
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Outcome_Physical
Blood urea
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Outcome_Mortality
all-cause mortality
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Outcome_Adverse-effects
variety of adverse outcomes
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Outcome_Other
accuracy
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Outcome_Other
moderate accuracy
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Participant_Condition
acute heart failure
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Participant_Condition
Hospitalized With Acute Decompensated Heart Failure and Volume Overload
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Participant_Condition
Acute heart failure
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Participant_Sample-size
2033
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Participant_Condition
admitted with acute heart failure
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Participant_Condition
acute heart failure