BMJ Open 3:e002254 doi:10.1136/bmjopen-2012-002254
  • Cardiovascular medicine
    • Research

Assessment of a multimarker strategy for prediction of mortality in older heart failure patients: a cohort study

  1. Michael L X Fu1
  1. 1Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Gothenburg, Sweden
  2. 2Department of Medicine, Centre for Applied Biostatistics, University of Gothenburg, Gothenburg, Sweden
  3. 3Department of Clinical Chemistry and Transfusion Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  1. Correspondence to Dr Michael L X Fu; Michael.fu{at}
  • Received 25 October 2012
  • Accepted 8 February 2013
  • Published 9 March 2013


Objective Primarily to develop a multimarker score for prediction of 3-year mortality in older patients with decompensated heart failure (HF).

Design Prospective cohort study.

Setting Secondary care. Single centre.

Patients and biomarkers 131 patients, aged ≥65 years, with decompensated HF were included. Assessment of biomarkers was performed at discharge.

Primary outcome measure 3-year mortality.

Results Mean age was 73±11 years; mean left ventricular ejection fraction , 43±14%; 53% were male. The 3-year mortality was 53.4%. The following N-terminal brain natriuretic peptide (NTproBNP) levels could optimally stratify mortality: <2000 ng/l (n=39), 30.8% mortality; 2000–8000 ng/l (n=58), 51.7% mortality; and >8000 ng/l (n=34), 82.4% mortality. However, in the 2000–8000 ng/l range, NTproBNP levels had low-prognostic capacity, based on the area under the receiver operating characteristic curve (AUC=0.53; 95% CI 0.40 to 0.67). In this group, multivariate analysis identified age, cystatin C (CysC), and troponin T (TnT) levels as independent risk factors. A risk score based on these three risk factors separated a high-risk and low-risk groups within the NTproBNP range of 2000–8000 ng/l. The score exhibited a significantly higher AUC (0.75; 95% CI 0.62 to 0.86) than NTproBNP alone (p=0.03) in this NTproBNP group and had similar prognostic capacity as NTproBNP in patients below or above this NTproBNP range (p=0.57). Net reclassification improvement and integrated discriminatory improvement in the group with NTproBNP levels between 2000 and 8000 ng/l was 54% and 23%, respectively, and in the whole cohort 22% and 11%, respectively.

Conclusions Our results suggested that, to assess risk in HF, older patients required significantly higher levels of NTproBNP than younger patients. Furthermore, a risk score that included TnT and CysC at discharge, and age could improve risk stratification for mortality in older patients with HF in particular when NTproBNP was moderately elevated.


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