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A Multi-Marker Approach for Risk Stratification in Patients With Chronic Heart Failure: Insights From the HF-ACTION Trial

Publication ,  Conference
Sharma, A; Stevens, SR; Coles, A; Fiuzat, M; Adams, KF; Whellan, DJ; Donahue, MP; Kitzman, DW; Pi na, IL; Zannad, F; Kraus, WE; O Connor, CM ...
2017

Introduction: It is unclear whether multi-marker approaches improve risk stratification among patients with heart failure (HF). We evaluated the prognostic utility of a multi-marker approach with biomarkers of HF status; Growth-differentiation factor-15 (GDF-15), galectin-3 (Gal-3), ST2, NT-proBNP, C- reactive protein (CRP), and high sensitivity troponin (hs TnT) in the setting of established clinical outcomes markers.Methods: The NHLBI Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION) trial randomized 2331 patients with HFrEF to exercise training or usual care. Median follow-up was 30 months. Cox proportional hazard models assessed the prognostic utility of adding the biomarkers to the validated HF-ACTION risk model for the following outcomes: all-cause death; all-cause death or rehospitalization; and cardiovascular (CV) death or HF hospitalization. Hazard ratios (HR; per doubling of biomarker), C-statistics, and integrated discrimination improvement (IDI) with 95% confidence interval (CI) were calculated.Results: Among patients with baseline biomarker measurements (n=912), the median age was 59.2 years (50.6-68.4), 28.9% were female, and 50.5% had an ischemic etiology of HF. When the 6 biomarkers were added to the clinical model, NT-proBNP had the strongest association with outcomes (figure). In addition, the panel of biomarkers improved discrimination for all-cause death (c-statistic from 0.71 to 0.77; IDI 0.08 95% CI 0.06, 0.11), all-cause mortality or rehospitalization (c-statistic from 0.61 to 0.64; IDI 0.05, 95% CI 0.04, 0.07), and CV death or HF hospitalization (c-statistic from 0.71 to 0.76; IDI 0.06, 95% CI 0.04, 0.08).Conclusion: In well characterized patients with HFrEF, a multi-marker approach improved risk stratification over established clinical outcome predictors. Routine use of a multi-marker approach for risk stratification in clinical practice warrants further evaluation.Author Disclosures: A. Sharma: Other Research Support; Modest; Takeda, Roche diagnostic. S.R. Stevens: None. A. Coles: None. M. Fiuzat: Other Research Support; Significant; Roche diagnostics. K.F. Adams: Other Research Support; Significant; Roche diagnostics. D.J. Whellan: None. M.P. Donahue: None. D.W. Kitzman: None. I.L. Pi na: None. F. Zannad: Honoraria; Significant; Roche Diagnostic. W.E. Kraus: None. C.M. O’Connor: Research Grant; Significant; Roche diagnostics. G. Felker: Research Grant; Significant; Amgen, Roche Diagnostics. Other Research Support; Significant; Amgen. Consultant/Advisory Board; Significant; Amgen.

Duke Scholars

ISSN

0009-7322

Publication Date

2017

Volume

136

Start / End Page

A17332 / A17332

Publisher

American Heart Association, Inc.

Related Subject Headings

  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Sharma, A., Stevens, S. R., Coles, A., Fiuzat, M., Adams, K. F., Whellan, D. J., … Felker, G. M. (2017). A Multi-Marker Approach for Risk Stratification in Patients With Chronic Heart Failure: Insights From the HF-ACTION Trial (Vol. 136, pp. A17332–A17332). American Heart Association, Inc.
Sharma, Abhinav, Susanna R. Stevens, Adrian Coles, Mona Fiuzat, Kirkwood F. Adams, David J. Whellan, Mark P. Donahue, et al. “A Multi-Marker Approach for Risk Stratification in Patients With Chronic Heart Failure: Insights From the HF-ACTION Trial,” 136:A17332–A17332. American Heart Association, Inc., 2017.
Sharma A, Stevens SR, Coles A, Fiuzat M, Adams KF, Whellan DJ, et al. A Multi-Marker Approach for Risk Stratification in Patients With Chronic Heart Failure: Insights From the HF-ACTION Trial. In American Heart Association, Inc.; 2017. p. A17332–A17332.
Sharma, Abhinav, et al. A Multi-Marker Approach for Risk Stratification in Patients With Chronic Heart Failure: Insights From the HF-ACTION Trial. Vol. 136, American Heart Association, Inc., 2017, pp. A17332–A17332.
Sharma A, Stevens SR, Coles A, Fiuzat M, Adams KF, Whellan DJ, Donahue MP, Kitzman DW, Pi na IL, Zannad F, Kraus WE, O Connor CM, Felker GM. A Multi-Marker Approach for Risk Stratification in Patients With Chronic Heart Failure: Insights From the HF-ACTION Trial. American Heart Association, Inc.; 2017. p. A17332–A17332.

ISSN

0009-7322

Publication Date

2017

Volume

136

Start / End Page

A17332 / A17332

Publisher

American Heart Association, Inc.

Related Subject Headings

  • Cardiovascular System & Hematology
  • 4207 Sports science and exercise
  • 3202 Clinical sciences
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1103 Clinical Sciences
  • 1102 Cardiorespiratory Medicine and Haematology