The Stanford acute heart failure symptom score for patients hospitalized with heart failure.

Autor:	Almond CS; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California. Electronic address: christopher.almond@stanford.edu., Chen S; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Dykes JC; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Kwong J; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Burstein DS; Department of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania., Rosenthal DN; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Kipps AK; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Teuteberg J; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California., Murray JM; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Kaufman BD; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Hollander SA; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Profita E; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Yarlagadda VY; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Sacks LD; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California., Chen CY; Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Palo Alto, California.
Jazyk:	angličtina
Zdroj:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2020 Nov; Vol. 39 (11), pp. 1250-1259. Date of Electronic Publication: 2020 Aug 08.
DOI:	10.1016/j.healun.2020.08.002
Abstrakt:	Background: Currently, there are no simple tools to evaluate the acute heart failure (HF) symptom severity in children hospitalized with acute decompensated HF (ADHF). We sought to develop an inpatient HF score (HFS) that could be used as a clinical tool and for clinical trials. Methods: Pediatric HF clinicians at Stanford reviewed the limitations of existing HFSs, which include lack of calibration to the inpatient setting, omission of gastrointestinal symptoms, need for multiple age-based tools, and scores that prioritize treatment intensity over patient symptoms. To address these, we developed an acute HFS corresponding to the 3 cardinal symptoms of HF: difficulty with breathing, feeding, and activity. The score was iteratively improved over a 3-year pilot phase until no further changes were made. The inter-rater reliability (IRR) across a range of providers was assessed using the final version. Peak HFSs were analyzed against mortality and length of stay (LOS) for all pediatric HF discharges between July and October 2019. Results: The final HFS was a 4-point ordinal severity score for each of the 3 symptom domains (total score 0-12). Among clinicians who scored 12 inpatients with ADHF simultaneously, the intraclass correlation (ICC) was 0.94 (respiratory ICC = 0.89, feeding ICC = 0.85, and activity ICC = 0.80). Score trajectory reflected our clinical impression of patient response to HF therapies across a range of HF syndromes including 1- and 2-ventricle heart disease and reduced or preserved ejection fraction. Among the 28 patients hospitalized during a 3-months period (N = 28), quartiles of peak score were associated with LOS (p < 0.01) and in-hospital mortality (p < 0.01): HFS 0 to 3 (median LOS of 5 days and mortality of 0%), HFS 4 to 6 (median LOS of 18 days and mortality of 0%), HFS 5 to 9 (median LOS of 29 days and mortality of 23%), and HFS 10 to 12 (median LOS of 121 days and mortality of 50%). Conclusion: This simple acute HFS may be a useful tool to quantify and monitor day-to-day HF symptoms in children hospitalized with ADHF regardless of etiology or age group. The score has excellent IRR across provider levels and is associated with major hospital outcomes supporting its clinical validity. Validation in a multicenter cohort is warranted. (Copyright © 2020. Published by Elsevier Inc.)
Databáze:	MEDLINE
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