Abstract 19829: Get With the Guidelines Heart Failure Risk Score and Post-Discharge Events in Hospitalized Heart Failure Patients

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Abstract

Background: The Get with the Guidelines (GWTG) heart failure (HF) Risk Score was developed in the GWTG inpatient HF registry to predict inpatient mortality but has not been validated in the community setting or for post-discharge outcomes.

Methods: The 100 point GWTG score uses 7 admission variables (blood urea nitrogen, systolic blood pressure, age, sodium, heart rate, race, and lung disease) to place patients into 9 categories at incremental risk for inpatient mortality. In this community-based study of all HF hospitalizations (5794 HF admissions in 3628 patients) from 2000-2013, we examined the predictive characteristics of the GWTG score for inpatient and post-discharge mortality and all-cause or HF readmission.

Results: In the community, the GWTG score was well calibrated for inpatient mortality in the 98% of admissions that fell in the 4 lowest GWTG risk strata, but not for those in the 5 highest risk strata (Figure). Pre- and post-discharge mortality increased across GWTG risk quintiles (c-statistics ≥ 0.70; Table). Admissions in the highest GWTG quintile had a 10-18 fold higher risk of inpatient or post-discharge mortality than the lowest quintile. The 180-day mortality was nearly 50% in the highest quintile (GWTG score >50), a prognostic benchmark for consideration of hospice referral. The GWTG score had less robust predictive characteristics for readmission (c-statistic 0.57 to 0.64) than mortality (Table).

Conclusion: In the community, the GWTG score stratifies HF patients on admission into groups that differ substantially in both in-hospital and post-discharge adverse outcomes and may inform longer term care decisions and discharge planning.

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