TY - JOUR
T1 - Evaluation of the incremental prognostic utility of increasingly complex testing in chronic heart failure
AU - Ahmad, Tariq
AU - O'Brien, Emily C.
AU - Schulte, Phillip J.
AU - Stevens, Susanna R.
AU - Fiuzat, Mona
AU - Kitzman, Dalane W.
AU - Adams, Kirkwood F.
AU - Kraus, William E.
AU - Piña, Ileana L.
AU - Donahue, Mark P.
AU - Zannad, Faiez
AU - Whellan, David J.
AU - O'Connor, Christopher M.
AU - Michael Felker, G.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background-Current heart failure (HF) risk prediction models do not consider how individual patient assessments occur in incremental steps; furthermore, each additional diagnostic evaluation may add cost, complexity, and potential morbidity. Methods and Results-Using a cohort of well-Treated ambulatory HF patients with reduced ejection fraction who had complete clinical, laboratory, health-related quality of life, imaging, and exercise testing data, we estimated incremental prognostic information provided by 5 assessment categories, performing an additional analysis on those with available N-Terminal pro-B-Type natriuretic peptide (NT-proBNP) levels. We compared the incremental value of each additional assessment (quality of life screen, laboratory testing, echocardiography, and exercise testing) to baseline clinical assessment for predicting clinical outcomes (all-cause mortality, all-cause mortality/hospitalization, and cardiovascular death/HF hospitalizations), gauging incremental improvements in prognostic ability with more information using area under the curve and reclassification improvement (net reclassification index), with and without NT-proBNP availability. Of 2331 participants, 1631 patients had complete clinical data; of these, 1023 had baseline NT-proBNP. For prediction of all-cause mortality, models with incremental assessments sans NT-proBNP showed improvements in C-indices (0.72 [clinical model alone]-0.77 [complete model]). Compared with baseline clinical assessment alone, net reclassification index improved from 0.035 (w/laboratory data) to 0.085 (complete model). These improvements were significantly attenuated for models in the subset with measured NT-proBNP data (c-indices: 0.80 [w/laboratory data]-0.81 [full model]); net reclassification index improvements were similarly marginal (0.091→0.096); prediction of other clinical outcomes had similar findings. Conclusions-In chronic HF patients with reduced ejection fraction, the marginal benefit of complex prognostic evaluations should be weighed against potential patient discomfort and cost escalation. copy; 2015 American Heart Association, Inc.
AB - Background-Current heart failure (HF) risk prediction models do not consider how individual patient assessments occur in incremental steps; furthermore, each additional diagnostic evaluation may add cost, complexity, and potential morbidity. Methods and Results-Using a cohort of well-Treated ambulatory HF patients with reduced ejection fraction who had complete clinical, laboratory, health-related quality of life, imaging, and exercise testing data, we estimated incremental prognostic information provided by 5 assessment categories, performing an additional analysis on those with available N-Terminal pro-B-Type natriuretic peptide (NT-proBNP) levels. We compared the incremental value of each additional assessment (quality of life screen, laboratory testing, echocardiography, and exercise testing) to baseline clinical assessment for predicting clinical outcomes (all-cause mortality, all-cause mortality/hospitalization, and cardiovascular death/HF hospitalizations), gauging incremental improvements in prognostic ability with more information using area under the curve and reclassification improvement (net reclassification index), with and without NT-proBNP availability. Of 2331 participants, 1631 patients had complete clinical data; of these, 1023 had baseline NT-proBNP. For prediction of all-cause mortality, models with incremental assessments sans NT-proBNP showed improvements in C-indices (0.72 [clinical model alone]-0.77 [complete model]). Compared with baseline clinical assessment alone, net reclassification index improved from 0.035 (w/laboratory data) to 0.085 (complete model). These improvements were significantly attenuated for models in the subset with measured NT-proBNP data (c-indices: 0.80 [w/laboratory data]-0.81 [full model]); net reclassification index improvements were similarly marginal (0.091→0.096); prediction of other clinical outcomes had similar findings. Conclusions-In chronic HF patients with reduced ejection fraction, the marginal benefit of complex prognostic evaluations should be weighed against potential patient discomfort and cost escalation. copy; 2015 American Heart Association, Inc.
KW - Brain
KW - Echocardiography
KW - Heart Failure
KW - Hospitalization
KW - Natriuretic Peptide
KW - Quality Of Life
UR - http://www.scopus.com/inward/record.url?scp=84942887862&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942887862&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.114.001996
DO - 10.1161/CIRCHEARTFAILURE.114.001996
M3 - Article
C2 - 26034004
AN - SCOPUS:84942887862
SN - 1941-3289
VL - 8
SP - 709
EP - 716
JO - Circulation: Heart Failure
JF - Circulation: Heart Failure
IS - 4
ER -