The modified Rajan's heart failure risk score predicts all-cause mortality in patients hospitalized for heart failure with reduced ejection fraction: a retrospective cohort study

Rajesh Rajan; Jeremy Man Ho Hui; Mohammad A Al Jarallah; Gary Tse; Jeffrey Shi Kai Chan; Danish Iltaf Satti; Chloe Tsz Ching Hui; Yuxi Sun; Yan Hiu Athena Lee; Ying Liu; Govindan Vijayaraghavan; Ibrahim Al-Zakwani; Laura AlObaid

doi:10.1097/MS9.0000000000001646

The modified Rajan's heart failure risk score predicts all-cause mortality in patients hospitalized for heart failure with reduced ejection fraction: a retrospective cohort study

Ann Med Surg (Lond). 2024 Feb 28;86(4):1843-1849. doi: 10.1097/MS9.0000000000001646. eCollection 2024 Apr.

Authors

Affiliations

¹ Department of Cardiology, Sabah Al Ahmad Cardiac Center, Kuwait City, Kuwait.
² Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, Hong Kong, China-United Kingdom collaboration.
³ Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
⁴ Heart Failure and Structural Cardiology Division, First Affiliated Hospital of Dalian Medical University, Dalian, China.
⁵ Department of Cardiology, Kerala Institute of Medical Sciences, Kerala, India.
⁶ Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman & Gulf Health Research, Muscat, Oman.
⁷ Department of Medicine, Faculty of Medicine, Royal College of Surgeons, Dublin, Ireland.

Abstract

Background: The dimensionless Rajan's heart failure (R-hf) risk score was proposed to predict all-cause mortality in patients hospitalized with chronic heart failure (HF) and reduced ejection fraction (EF) (HFrEF).

Purpose: To examine the association between the modified R-hf risk score and all-cause mortality in patients with HFrEF.

Methods: Retrospective cohort study included adults hospitalized with HFrEF, as defined by clinical symptoms of HF with biplane EF less than 40% on transthoracic echocardiography, at a tertiary centre in Dalian, China, between 1 November 2015, and 31 October 2019. All patients were followed up until 31 October 2020. A modified R-hf risk score was calculated by substituting brain natriuretic peptide (BNP) for N-terminal prohormone of BNP (NT-proBNP) using EF× estimated glomerular filtration rate (eGFR)× haemoglobin (Hb))/BNP. The patients were stratified into tertiles according to the R-hf risk score. The measured outcome was all-cause mortality. The score performance was assessed using C-statistics.

Results: A total of 840 patients were analyzed (70.2% males; mean age, 64±14 years; median (interquartile range) follow-up 37.0 (27.8) months). A lower modified R-hf risk score predicted a higher risk of all-cause mortality, independent of sex and age [1st tertile vs. 3rd tertile: adjusted hazard ratio (aHR), 3.46; 95% CI: 2.11-5.67; P<0.001]. Multivariate Cox regression analysis indicated that a lower modified R-hf risk score was associated with increased cumulative all-cause mortality [univariate: (1st tertile vs. 3rd tertile: aHR, 3.45; 95% CI: 2.11-5.65; P<0.001) and multivariate: (1st tertile vs. 3rd tertile: aHR 2.21, 95% CI: 1.29-3.79; P=0.004)]. The performance of the model, as reported by C-statistic was 0.67 (95% CI: 0.62-0.72).

Conclusion: The modified R-hf risk score predicted all-cause mortality in patients hospitalized with HFrEF. Further validation of the modified R-hf risk score in other cohorts of patients with HFrEF is needed before clinical application.

Keywords: Asia; R-hf risk score; chronic heart failure; heart failure reduced ejection fraction; mortality.