Clinical InvestigationRisk stratification after hospitalization for decompensated heart failure☆
Section snippets
Methods
The study design and primary results of the OPTIME-CHF study have been published elsewhere.20., 21. Briefly, the OPTIME study randomized 949 patients with systolic dysfunction and exacerbations of heart failure to receive 48 to 72 hours of intravenous milrinone therapy (0.5 μg·kg·min without a loading dose) or placebo. Patients were randomized as soon as possible on presentation to the emergency department or hospital (no longer than a 48-hour delay between presentation and randomization).
Results
Baseline characteristics for the patients enrolled in OPTIME-CHF stratified by 60-day outcomes are shown in Table 1. Patients were generally admitted with evidence of volume overload, with the majority of patients demonstrating elevated jugular venous pressure (68%). Baseline hemodynamics tended to be in the normal range, with a median systolic blood pressure of 120 (105–134) mm Hg and median heart rate of 84 (72–96) beats/min. The risk of adverse events at 60 days was substantial, with 60-day
Discussion
Despite advancements in the treatment of heart failure, the morbidity and mortality associated with this clinical syndrome remain high. Although decompensated heart failure is common and associated with substantial morbidity and mortality, features that accurately predict adverse events have not been well defined. Using data from the OPTIME-CHF trial, we developed a predictive model to help assess the risk of 60-day mortality or death + rehospitalization at 60 days in patients hospitalized with
Conclusions
To our knowledge, this is the most powerful predictive model for adverse events in patients hospitalized with decompensated heart failure. By using easily determined clinical characteristics on admission, patients can be identified as high or low risk of death or rehospitalization at 60 days, potentially allowing adjustment of both the intensity and duration of hospital care and follow-up. The model for mortality was able to provide a high degree of discriminatory power using 5 baseline
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The OPTIME-CHF trial was sponsored by Sanofi-Synthelabo, Inc, but this study was funded independently by the Duke Clinical Research Institute.