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Derivation and validation of a simple clinical risk-model in heart failure based on 6 minute walk test performance and NT-proBNP status - Do we need specificity for sex and beta-blockers?

Katus, H.A.; Cleland, J.G.F.; Frankenstein, L.; Goode, K.; Clark, A.L.; Ingle, Lee; Ingle, Lee; Remppis, A.; Schellberg, D.; Nelles, M.; Katus, H. A.; Clark, A. L.; Cleland, J. G. F.; Zugck, C.

Authors

H.A. Katus

J.G.F. Cleland

L. Frankenstein

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Dr Kevin Goode K.M.Goode@hull.ac.uk
Research Systems Project Manager / Business Analyst

A.L. Clark A.L.Clark@hull.ac.uk

A. Remppis

D. Schellberg

M. Nelles

H. A. Katus

A. L. Clark

J. G. F. Cleland

C. Zugck



Abstract

BACKGROUND It is unclear whether risk prediction strategies in chronic heart failure (CHF) need to be specific for sex or beta-blockers. We examined this problem and developed and validated the consequent risk models based on 6-minute-walk-test and NT-proBNP. METHODS The derivation cohort comprised 636 German patients with systolic dysfunction. They were validated against 676 British patients with similar aetiology. ROC-curves for 1-year mortality identified cut-off values separately for specificity (none, sex, beta-blocker, both). Patients were grouped according to number of cut-offs met (group I/II/III - 0/1/2 cut-offs). RESULTS Widest separation between groups was achieved with sex- and beta-blocker-specific cut offs. In the derivation population, 1-year mortality was 0%, 8%, 31% for group I, II and III, respectively. In the validation population, 1-year rates in the three risk groups were 2%, 7%, 14%, respectively, after application of the same cut-offs. CONCLUSION Risk stratification for CHF should perhaps take sex and beta-blocker usage into account. We derived and independently validated relevant risk models based on 6-minute-walk-tests and NT-proBNP. Specifying sex and use of beta-blockers identified three distinct sub-groups with widely differing prognosis. In clinical practice, it may be appropriate to tailor the intensity of follow-up and/or the treatment strategy according to the risk-group.

Journal Article Type Article
Publication Date Feb 17, 2011
Journal International journal of cardiology
Print ISSN 0167-5273
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 147
Issue 1
Pages 74-78
APA6 Citation Frankenstein, L., Goode, K., Ingle, L., Remppis, A., Schellberg, D., Nelles, M., …Zugck, C. (2011). Derivation and validation of a simple clinical risk-model in heart failure based on 6 minute walk test performance and NT-proBNP status - Do we need specificity for sex and beta-blockers?. International journal of cardiology, 147(1), 74-78. https://doi.org/10.1016/j.ijcard.2009.08.005
DOI https://doi.org/10.1016/j.ijcard.2009.08.005
Keywords Chronic heart failure; Risk prediction; Beta-blockers; Sex
Publisher URL https://www.sciencedirect.com/science/article/pii/S0167527309008547?via%3Dihub
PMID 19765836
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