Prediction of in-hospital mortality by using get with the guideline-heart failure (GWTG-HF) risk scores in patients hospitalized with heart failure
Authors: Mahmood M , Banerjee S K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): University Grants Commission Bangladesh

Background
Prognostic stratification using readily available clinical data can assist clinical decision making in heart failure. Get with the Guideline- Heart Failure (GWTG-HF) score approved by American Heart Association (AHA) can be used to inform hospitals about the expected in-hospital mortality of their patients.

Purpose
This study aims to predict in-hospital mortality of patients with heart failure using GWTG-HF score in order to give evidence based therapy to high risk patients.

Methods
We have included patients who were hospitalized with a diagnosis of heart failure from February 2020 to 15 January 2021. A total of 2038 patients were admitted during this period of which 144 patients were diagnosed with heart failure (7%). The GWTG-HF risk score uses 7 clinical factors collected at admission. These are older age, low systolic blood pressure, elevated heart rate, low serum sodium, elevated BUN, presence of COPD, and ethnicity. The probability of in-hospital mortality is estimated for an individual patient by summing points assigned to the value of each predictor for a total point score within a range of 0-100. These scores were calculated for 144 heart failure patients involved in this study.

Results
Death occurred in 29 heart failure patients (20.13%). Mean age was 59 ±13 years. Male/female ratio was 3.65. All patients were ethnically Bangladeshi Asian. 60% of patients had left ventricular ejection fraction (LVEF) &lt;40%. Overall LVEF was median (IQR) 36% (30-45). Those who died were more likely to have a prior heart failure diagnosis and an LVEF &lt;40%. The observed mortality was 0% for the GWTG-HF score 0-33, 14.14% for 34-50, 42% for 51-57, 40% for 58-61 and 50% with a score of 62-65. The observed mortality of our patients were much higher than expected GWTG-HF score (20% vs 2.8%). The probable reasons for increased mortality in our study could be 1) The number of patients having LVEF &lt;40% is much higher (60%), 2) surgically uncorrected/absence of intervention for underlying valvular disease/advance heart failure/ischaemic cardiomyopathy, 3) different treatment regimens and non-compliance of patients regarding long-term medication. Additionally, those who died had higher serum creatinine and BUN and lower serum sodium and haemoglobin levels at admission. Further multi-centre study involving large population is needed to clarify higher death rate in heart failure patients in our population.

Conclusion
The GWTG-HF risk score can identify patients at high risk of in-hospital death to aid clinical decision making. The risk score could be used to inform hospitals about the expected mortality rates of patients with heart failure admitted to their hospital. Although GWTG-HF risk score is validated in different populations, the mortality rate in this study is greater than expected mortality due to aforementioned reasons. Abstract Figure. GWTG-HF Risk Score (Reference 1) Abstract Figure. Predicted and Observed Mortality Rates