Risk stratification of acute decompensated heart failure inhospital mortality using the adhere CART method: is there validation in a Brazilian cohort?

Background

Risk scores for inhospital mortality in acute decompensated heart failure (ADHF) using admission parameters have been used. The ADHERE registry developed the CART method using a regression tree analysis, which defined three sequential parameters: BUN (blood urea nitrogen) (above 43 mg/dl), systolic arterial pressure (below 115 mmHg) and seric creatinine (above 2.75 mg/dl).

Objective

To verify the validity of the ADHERE CART method to stratify the risk of inhospital mortality of patients admitted with ADHF in a high-complexity Brazilian hospital.

Methods

Three hundred and eighty-six patients were admitted to a high-complexity private Brazilian hospital with ADHF from January 2006 to December 2007. On a retrospective form they were submitted to an inhospital risk stratification using the ADHERE CART model. The inclusion criteria consisted of patients with heart failure at admission and left ventricle ejection fraction <45%.

Results

The CART method parameters were reproduced in our data; however, just BUN demonstrated statistical significance in mortality (P = 0.02). After this point there was no difference. (See Figure 1.)

Figure 1

abstract

Conclusion

Only BUN had an impact on the inhospital mortality stratification in this population. The absence of heart failure with preserved ejection fraction and the reduced number of patients could be the reason for low correlation. National registries in ADHF are fundamental to determine in an unequivocal manner the mortality factors in the Brazilian population making possible the development of risk stratification scores fitting our reality.