A Validated Risk Score for In-Hospital Mortality in Patients With Heart Failure From the American Heart Association Get With the Guidelines Program
Abstract
Background— Effective risk stratification can inform clinical decision-making. Our objective was to derive and validate a risk score for in-hospital mortality in patients hospitalized with heart failure using American Heart Association Get With the Guidelines–Heart Failure (GWTG-HF) program data. Methods and Results— A cohort of 39 783 patients admitted January 1, 2005, to June 26, 2007, to 198 hospitals participating in GWTG-HF was divided into derivation (70%, n=27 850) and validation (30%, n=11 933) samples. Multivariable logistic regression identified predictors of in-hospital mortality in the derivation sample from candidate demographic, medical history, and laboratory variables collected at admission. In-hospital mortality rate was 2.86% (n=1139). Age, systolic blood pressure, blood urea nitrogen, heart rate, sodium, chronic obstructive pulmonary disease, and nonblack race were predictive of in-hospital mortality. The model had good discrimination in the derivation and validation datasets (c-index, 0.75 in each). Effect estimates from the entire sample were used to generate a mortality risk score. The predicted probability of in-hospital mortality varied more than 24-fold across deciles (range, 0.4% to 9.7%) and corresponded with observed mortality rates. The model had the same operating characteristics among those with preserved and impaired left ventricular systolic function. The morality risk score can be calculated on the Web-based calculator available with the GWTG-HF data entry tool. Conclusions— The GWTG-HF risk score uses commonly available clinical variables to predict in-hospital mortality and provides clinicians with a validated tool for risk stratification that is applicable to a broad spectrum of patients with heart failure, including those with preserved left ventricular systolic function.
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The AHA score adds three points to patients identified as nonblack, so black patients are classified as lower risk.
“It assigns three additional points to any patient identified as “nonblack,” thereby categorizing all black patients as being at lower risk.”
From Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms (2020) · cites this paper as [9]
The AHA Get with the Guidelines-Heart Failure Risk Score predicts in-hospital death risk for admitted heart-failure patients.
“The American Heart Association (AHA) Get with the Guidelines-Heart Failure Risk Score predicts the risk of death in patients admitted to the hospital.9”
From Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms (2020) · cites this paper as [9]
Clinicians are advised to use the AHA risk score to guide cardiology referral and resource allocation.
“Clinicians are advised to use this risk score to guide decisions about referral to cardiology and allocation of health care resources.”
From Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms (2020) · cites this paper as [9]
The AHA gives no rationale for the race adjustment.
“The AHA does not provide a rationale for this adjustment.”
From Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms (2020) · cites this paper as [9]
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- Authors
- Peterson, P. N., Rumsfeld, J. S., Liang, L., Albert, N. M., Hernandez, A. F., Peterson, E. D., Fonarow, G. C., & Masoudi, F. A.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Masoudi, Frederick A.
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2010-01
- Volume
- 3
- Issue
- 1
- Pages
- 25-32
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W2151185534
- Cited by
- 568
- References
- 20
- Citations by year
- 2026: 35 · 2025: 47 · 2024: 64 · 2023: 57 · 2022: 53 · 2021: 68 · 2020: 41 · 2019: 32 · 2018: 29 · 2017: 24 · 2016: 26 · 2015: 15 · 2014: 12 · 2013: 32 · 2012: 16
- FWCI
- 7.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association
- GlaxoSmithKline
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- heart failure, in-hospital mortality, mortality risk score, risk stratification, prognostic model, preserved left ventricular systolic function, chronic obstructive pulmonary disease, blood urea nitrogen, sodium, systolic blood pressure, heart rate, racial disparities
- MeSH terms
- Aged, Aged, 80 and over, American Heart Association, Female, Health Status Indicators, Heart Failure, Humans, Inpatients, Male, Middle Aged, Predictive Value of Tests, Registries, Risk Factors, ROC Curve, Systole, Time Factors, United States, Reproducibility of Results, Cohort Studies, Chi-Square Distribution, Logistic Models, Ventricular Function, Left, Hospital Mortality, Practice Guidelines as Topic, Risk Assessment, Guideline Adherence
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