The predictive discriminative power for short term prognosis of the GWTG score alongside LVEF and TAPSE in acute heart failure based on clinical presentation

Acute heart failure (AHF) has become a significant public health issue due to high hospitalization costs and resource consumption. Several prognostic scores have been developed based on various clinical and paraclinical parameters.

To apply an established score, the Get With the Guidelines Heart Failure Risk Score (GWTG) to a cohort of AHF patients divided based on the form of presentation- acute decompensated heart failure(ADHF) and acute pulmonary edema(APE) in order to identify statistically significant (SS) differences regarding in-hospital mortality(IHM), 1-month mortality(M1M), 1-month rehospitalization(R1M), 1-month survival(S1M). Stratifying the results based on echocardiographic parameters (left ventricular ejection fraction [LVEF], tricuspid annular plane systolic excursion [TAPSE]).

We retrospectively analyzed a cohort of 112 AHF patients, divided based on the form of presentation- ADHF and APE. We applied the GWTG score, which consists of clinical parameters (age, blood pressure, ventricular rate, history of COPD, race) and biological parameters (Na, BUN), to admitted patients between March 2023-December 2023. Cut-off values were set at >58 points (associated with >10% risk of IHM) and >70 points (associated with >30% risk of IHM). Stratification was made based on classic and easily obtainable echocardiographic parameters (LVEF, TAPSE). SS differences were sought between the two groups, as well as for the entire cohort.

Regardless of the form of presentation, patients with scores >58 points showed SS IHM (p<0.01). The prognostic power of the score increased when stratified by LVEF<50% (p<0.001). Patients with scores >70 points showed SS M1M (p<0.01). S1M for scores <58 points was SS(p<0.001). ADHF patients with scores >58 points had an increased risk of IHM (p<0.001), as well as when stratified by LVEF<50% (p<0.001). Patients with scores >70 points showed SS M1M (p<0.01). TAPSE did not SS differentiate the analyzed groups(p=0.03). For patients with APE there were no SS differences, regardless of score(IHM- p=0,35, M1M- p=0,4, R1M- p=0,24, S1M- p=0,36).

Applied to the entire cohort, the score predicted IHM in patients with >58 points, with increased prognostic power when LVEF<50% was added to the analysis. For patients with >70 points, the score was not SS for IHM, but was SS for M1M. In the entire cohort, S1M can be predicted using this score. When divided into the two groups, the score maintained predictive value for ADHF patients concerning IHM and M1M, as well as its correlation with LVEF, but was not SS for S1M. TAPSE did not increase the prognostic power of the score in any of the groups studied. The score proves useful for the entire AHF cohort and especially for ADHF patients, but lacks prognostic value for APE patients. This highlights that APE patients have a different hemodynamic profile, that needs to correlated with different echocardiographic parameters.