Abstract:
Aims Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation
attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during
the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary
care settings.
Methods and results HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14
primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries.
The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation
and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation
cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the
derivation cohort and 58.8% in the validation one (P = 0.004). Mortality/hospitalization during the first 30 days after a decom pensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic
regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds
ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles
(OR: 2.35; P = 0.01), New York Heart Association functional class III/IV (OR: 2.11; P = 0.001), oxygen saturation ≤ 90% (OR:
4.98; P < 0.001), heart rate > 100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45;
P < 0.001). The model showed an area under the curve (AUC) of 0.807, 95% confidence interval (CI): [0.770; 0.845] in the
derivation cohort and AUC 0.73, 95% CI: [0.660; 0.808] in the validation one. No significant differences between both
cohorts were observed (P = 0.08). Regarding probability of hospitalization/death, three risk groups were defined: low <5%,
medium 5–20%, and high >20%. Outcome incidence was 2.7% for the low-risk group, 12.8% for medium risk, and 46.2%
for high risk in the derivation cohort, and 9.1%, 12.9%, and 39.6% in the validation one.
Conclusions The HEFESTOS score, based on variables easily accessible in a community setting and validated in an external
European cohort, properly predicted the risk of death/hospitalization during the first 30 days after an HF decompensation
episode.