Evaluation of the Incremental Prognostic Utility of Increasingly Complex Testing in Chronic Heart FailureCLINICAL PERSPECTIVE

Autor: Ahmad, Tariq, O'Brien, Emily, Schulte, Phillip, Stevens, Susanna, Fiuzat, Mona, Kitzman, Dalane, Adams, Kirkwood, Kraus, William, Piña, Ileana, Donahue, Mark, Zannad, Faiez, Whellan, David, O'Connor, Christopher, Felker, G Michael
Přispěvatelé: Yale University School of Medicine, Duke Clinical Research Institute (DCRI), Duke University [Durham], Duke University Medical Center, Wake Forest University, University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Montefiore Medical Center, Service de Cardiologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Thomas Jefferson University, Inova Heart and Vascular Institute
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Zdroj: Circulation. Heart failure
Circulation. Heart failure, Lippincott Williams & Wilkins, 2015, 8 (4), pp.709-716. ⟨10.1161/CIRCHEARTFAILURE.114.001996⟩
ISSN: 1941-3289
1941-3297
DOI: 10.1161/CIRCHEARTFAILURE.114.001996⟩
Popis: International audience; BACKGROUND:Current heart failure (HF) risk prediction models do not consider how individual patient assessments occur in incremental steps; furthermore, each additional diagnostic evaluation may add cost, complexity, and potential morbidity.METHODS AND RESULTS:Using a cohort of well-treated ambulatory HF patients with reduced ejection fraction who had complete clinical, laboratory, health-related quality of life, imaging, and exercise testing data, we estimated incremental prognostic information provided by 5 assessment categories, performing an additional analysis on those with available N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. We compared the incremental value of each additional assessment (quality of life screen, laboratory testing, echocardiography, and exercise testing) to baseline clinical assessment for predicting clinical outcomes (all-cause mortality, all-cause mortality/hospitalization, and cardiovascular death/HF hospitalizations), gauging incremental improvements in prognostic ability with more information using area under the curve and reclassification improvement (net reclassification index), with and without NT-proBNP availability. Of 2331 participants, 1631 patients had complete clinical data; of these, 1023 had baseline NT-proBNP. For prediction of all-cause mortality, models with incremental assessments sans NT-proBNP showed improvements in C-indices (0.72 [clinical model alone]-0.77 [complete model]). Compared with baseline clinical assessment alone, net reclassification index improved from 0.035 (w/laboratory data) to 0.085 (complete model). These improvements were significantly attenuated for models in the subset with measured NT-proBNP data (c-indices: 0.80 [w/laboratory data]-0.81 [full model]); net reclassification index improvements were similarly marginal (0.091→0.096); prediction of other clinical outcomes had similar findings.CONCLUSIONS:In chronic HF patients with reduced ejection fraction, the marginal benefit of complex prognostic evaluations should be weighed against potential patient discomfort and cost escalation.CLINICAL TRIAL REGISTRATION:URL: http://www.clinicaltrials.gov. Unique identifier: NCT00047437.
Databáze: OpenAIRE
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