Skip to main content
Journal cover image

Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE).

Publication ,  Journal Article
DeVore, AD; Greiner, MA; Sharma, PP; Qualls, LG; Schulte, PJ; Cooper, LB; Mentz, RJ; Pang, PS; Fonarow, GC; Curtis, LH; Hernandez, AF
Published in: Am Heart J
August 2016

BACKGROUND: A subset of patients hospitalized with acute heart failure experiences in-hospital worsening heart failure, defined as persistent or worsening signs or symptoms requiring an escalation of therapy. METHODS: We analyzed data from the Acute Decompensated Heart Failure National Registry (ADHERE) linked to Medicare claims to develop and validate a risk model for in-hospital worsening heart failure. Our definition of in-hospital worsening heart failure included events such as escalation of medical therapy (eg, inotropic medications) >12hours after admission. We considered candidate risk prediction variables routinely assessed at admission, including age, medical history, biomarkers, and renal function. We used logistic regression with robust standard errors to generate a risk model in a 66% random derivation sample; we validated the model in the remaining 34%. We evaluated the calibration and discrimination of the model in both samples. RESULTS: We evaluated 23,696 patients hospitalized with acute heart failure. Baseline characteristics were well matched in the derivation and validation samples, and the occurrence of in-hospital worsening heart failure was similar in both samples (15.4% and 15.6%, respectively). In the multivariable model, the strongest predictors of in-hospital worsening heart failure were increased troponin and creatinine. The model was well calibrated and had good discrimination in the derivation sample (c statistic, 0.74) and validation sample (c statistic, 0.72). CONCLUSIONS: The ADHERE worsening heart failure risk model is a clinical tool with good discrimination for use in patients hospitalized with acute heart failure to identify those at increased risk for in-hospital worsening heart failure. This tool may be useful to target treatment strategies for patients at high risk for in-hospital worsening heart failure.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2016

Volume

178

Start / End Page

198 / 205

Location

United States

Related Subject Headings

  • United States
  • Troponin
  • Stroke Volume
  • Risk Assessment
  • Registries
  • Natriuretic Peptide, Brain
  • Multivariate Analysis
  • Medicare
  • Male
  • Logistic Models
 

Citation

APA
Chicago
ICMJE
MLA
NLM
DeVore, A. D., Greiner, M. A., Sharma, P. P., Qualls, L. G., Schulte, P. J., Cooper, L. B., … Hernandez, A. F. (2016). Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J, 178, 198–205. https://doi.org/10.1016/j.ahj.2016.04.021
DeVore, Adam D., Melissa A. Greiner, Puza P. Sharma, Laura G. Qualls, Phillip J. Schulte, Lauren B. Cooper, Robert J. Mentz, et al. “Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE).Am Heart J 178 (August 2016): 198–205. https://doi.org/10.1016/j.ahj.2016.04.021.
DeVore AD, Greiner MA, Sharma PP, Qualls LG, Schulte PJ, Cooper LB, et al. Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2016 Aug;178:198–205.
DeVore, Adam D., et al. “Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE).Am Heart J, vol. 178, Aug. 2016, pp. 198–205. Pubmed, doi:10.1016/j.ahj.2016.04.021.
DeVore AD, Greiner MA, Sharma PP, Qualls LG, Schulte PJ, Cooper LB, Mentz RJ, Pang PS, Fonarow GC, Curtis LH, Hernandez AF. Development and validation of a risk model for in-hospital worsening heart failure from the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J. 2016 Aug;178:198–205.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2016

Volume

178

Start / End Page

198 / 205

Location

United States

Related Subject Headings

  • United States
  • Troponin
  • Stroke Volume
  • Risk Assessment
  • Registries
  • Natriuretic Peptide, Brain
  • Multivariate Analysis
  • Medicare
  • Male
  • Logistic Models