SPC365

GWTG-HF: A Stronger Predictor of Cardiovascular Mortality After Hospitalization

Session: Sessão de Posters 55 - Congestão, instabilidade e marcadores prognósticos na insuficiência cardíaca avançada
Speaker: Ana Rodrigo Costa

Congress: CPC 2026
Topic: D. Heart Failure
Theme: 11. Acute Heart Failure
Subtheme: 11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Ana Rodrigo Costa; Inês Gomes Campos; Mauro Moreira; José Luís Ferraro; Inês Bastos Castro; Joana Laranjeira Correia; Liliana Reis; Aurora Andrade

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Background: </span></strong><span style="font-size:10.0pt">Heart failure (HF) is a common disease with high morbidity and mortality. Several risk scores predict all-cause mortality, sudden cardiac death, and cardiovascular events in HF patients. The Get With the Guidelines &ndash; Heart Failure (GWTG</span><span style="font-size:10.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif">-</span></span><span style="font-size:10.0pt">HF) risk score predicts in</span><span style="font-size:10.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif">-</span></span><span style="font-size:10.0pt">hospital mortality in acute HF, using simple variables.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Aim: </span></strong><span style="font-size:10.0pt">To evaluate the prognostic impacts of the GWTG</span><span style="font-size:10.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif">-</span></span><span style="font-size:10.0pt">HF risk score in patients with HF after discharge.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Methods: </span></strong><span style="font-size:10.0pt">Retrospective single-center cohort study of adult patients hospitalized in 2022 with a diagnosis of acute HF.&nbsp;The GWTG-HF score was calculated using 7 predetermined variables, with all variable values obtained at admission.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Results: </span></strong><span style="font-size:10.0pt">A total of 255 patients (68.2% male; median age of&nbsp;73 years) were followed for a median of 463 days. The median GWTG-HF score was 44 (IQR, 44.7&ndash;47.2), with 20.8% scoring &ge;55 points. Higher scores were significantly associated with older age (p&lt;0.001), chronic kidney disease (p=0.017), chronic decompensated HF (p=0.034), right ventricular dysfunction (p=0.009) and higher NT-proBNP levels (p &lt; 0.001). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">In-hospital mortality was 3.9%, higher among patients with higher scores (50.0% vs. 19.6%; p=0.020), as did cardiovascular (CV) mortality (70.0% vs. 16.6%; p&lt;0.001) and all-cause mortality (40.9% vs. 18.9%; p=0.015). Logistic regression confirmed independent associations of higher scores with in-hospital mortality (OR 1.063; 95% CI 1.005&ndash;1.125; p=0.032) and CV mortality (OR 1.106; 95% CI 1.056&ndash;1.158; p&lt;0.001). ROC curve analysis showed moderate discrimination for in-hospital mortality (AUC 0.700; p=0.009) and good predictive accuracy for in-hospital CV mortality (AUC 0.811; p&lt;0.001). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">Post-discharge CV mortality was 5.5%, overall CV mortality was 7.8%. Patients who died post-discharge had higher GWTG-HF scores and NT-proBNP levels during hospitalization (p&lt;0.001), whereas admission LVEF was not predictive (p=0.119). The optimal GWTG-HF cutoff of 54.5 predicted post-discharge cardiovascular mortality with 78.6% sensitivity and 82.6% specificity (AUC 0.845; 95% CI 0.755&ndash;0.936). Notably, the post-discharge CV mortality curve showed the best ROC performance (AUC 0.845; 95% CI 0.755&ndash;0.936), compared with in-hospital and overall CV mortality. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Conclusions:&nbsp;</span></strong><span style="font-size:10.0pt">Originally developed to predict in</span><span style="font-size:10.0pt"><span style="font-family:&quot;Cambria Math&quot;,serif">-</span></span><span style="font-size:10.0pt">hospital mortality, the GWTG-HF score also provides prognostic value after discharge, extending into the chronic phase, </span><span style="font-size:10.0pt">as demonstrated in our cohort</span><span style="font-size:10.0pt">.</span></span></span></p>