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.

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.

Citation

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

• Journal Article Type: Article
• Acceptance Date: Aug 11, 2009
• Online Publication Date: Sep 7, 2009
• 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
• DOI: https://doi.org/10.1016/j.ijcard.2009.08.005
• Keywords: Chronic heart failure; Risk prediction; Beta-blockers; Sex
• Public URL: https://hull-repository.worktribe.com/output/423648
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S0167527309008547?via%3Dihub
• PMID: 19765836