Impact of R-hf Risk Score on All-Cause Mortality in Acute Heart Failure Patients in the Middle East

Abstract

Background: Treatment and control of blood pressure (BP) may improve outcomes in patients with heart failure (HF) with preserved and reduced ejection fraction. Updated AHA/ACC/HFSA guidelines from 2017 added a recommendation to target a systolic BP less than 130mm Hg for those with Stage C HF regardless of ejection fraction (Class of recommendation I, level of evidence C). Nationally representative data regarding rates of BP treatment and control in ambulatory HF patients are needed to identify gaps in achieving this goal and determine if racial disparities exist. Hypothesis: Treatment and control rates of BP are low in those with HF and vary by race. Methods: We evaluated BP treatment and control rates in adults age 20 years who identified as non-Hispanic (NH) black, NH white, or Hispanic with self-reported HF from the National Health and Nutrition Examination Surveys (NHANES) 1999-2016. We determined prevalence rates of BP treatment and control by race. Control BP (for those on BP treatment) or goal BP (for those not on BP treatment) was defined as <130/80 mm Hg. Odds ratios (OR) and 95% confidence intervals (CI) of control or goal BP of NH Black and Hispanic adults compared to NH whites were calculated with adjustment for age, sex, and proxies of SES (education level, health insurance, and income). All analyses accounted for the complex-weighted sampling design of NHANES. Results: Among 1240 adults with HF, mean age was 66 §0.5 years and 48% were female, 14% NH black, 9% Hispanic, and 69% were on BP treatment. Rate of BP treatment was highest in NH blacks (82%) compared with NH whites (65%) or Hispanics (55%) (p <0.001). However, the proportion of BP control among those on BP treatment was lowest among NH blacks (39%) compared with NH whites (51%) or Hispanic adults (45%). Among those not on BP treatment, there were no significant differences in rates of goal BP by race (NH blacks [41%], NH whites [53%], and Hispanics [57%]). After adjustments for age, sex, and SES, the OR (95% CI) of BP control for NH blacks on treatment was 0.62 (0.43, 0.91) compared to NH whites (TABLE ). Conclusions: Despite the fact that patients with HF constitute a high-risk population, we found low rates of BP treatment and control (defined by <130/80mm Hg). There was significant discordance between rates of treatment and control among NH blacks who had the highest rates of treatment but the lowest rates of BP control while on treatment. Focused efforts are needed to achieve the BP target set by the 2017 AHA/ACC/HFSA guidelines with attention towards eliminating disparities.

Validation of R-hf risk score for risk stratification in ischemic heart failure patients: A prospective cohort study

“…By integrating only four variables in the risk score (ejection fraction (EF,%), estimated glomerular filtration rate (e-GFR, mL/min), hemoglobin levels (Hb, g/dL), and N -terminal prohormone of brain natriuretic peptide (NT-proBNP, pg/mL) this offers a simple yet robust tool. For physicians, the application and the calculator is available online and is easily accessible at https://www.hfriskcalc.in [ 9 , 10 ].…”

“…is derived from the product of estimated glomerular filtration rate [eGFR (mL/min)], left ventricular ejection fraction [LVEF (%)], and haemoglobin levels [Hb (g/dL)] divided by N -terminal pro-brain natriuretic peptide [NT proBNP (pg/mL)]. A R-hf score of <5 indicates high risk, 5-<10 moderate risk, 10-<50 low risk [ 9 , 10 ]. The study was registered (KIMS1306/12), the ethical committee for health coordination and medical research at the Kerala Institute of Medical Sciences approved the study protocol and accepted.…”

“…However, these models generally incorporate complex mathematical formulas for risk assessment, requiring sophisticated techniques for calculation [ 6 ]. In contrast, the R-heart failure (R-hf) score is a unique risk-predicting tool that can be incorporated in risk assessment of patients with chronic heart failure with reduced ejection fraction (HFrEF) [ 9 , 10 ]. The purpose of this study is to validate the R–Hf risk score in patients with chronic ischemic heart failure.…”

The modified Rajan’s heart failure risk score predicts all-cause mortality in patients hospitalized for heart failure with reduced ejection fraction: a retrospective cohort study

“…The subjects were categorized into tertiles according to their respective R-hf risk scores. The 1st tertile was R-hf risk score less than or equal to 22.51, 2nd tertile was R-hf risk score greater than 22.51-68.10 and 3rd tertile was R-hf risk score greater than 68.10 11 , 12 . Descriptive statistics were used to summarize the data.…”

“…Multivariate models are available to predict prognostic outcomes for patients with HF 9 , 10 , but they are underutilized because of the complex mathematical calculations required 6 . In contrast, the Rajan’s heart failure (R-hf) risk score is a simple prognostic tool that uses readily available clinical variables: estimated glomerular filtration rate (eGFR), ejection fraction (EF), haemoglobin (Hb), and N-terminal prohormone BNP (NT-proBNP)) 11 , 12 which has been previously validated as a predictor of mortality in hospitalized patients with chronic HF reduced EF (HFrEF) 13 . This study aimed to determine the prognostic value of the Rajan HF score in patients hospitalized for HFrEF.…”