Heart failure & cardiomyopathiesDiagnostic or prognostic study
A Phenomapping Tool and Clinical Score to Identify Low Diuretic Efficiency in Acute Decompensated Heart Failure
- Prognostic model development and validation study
- machine learning-based phenomapping
- external validation
- pooled acute decompensated heart failure (ADHF) trials
Authors' conclusion
The authors developed and validated a phenomapping strategy and diuresis score for individuals with ADHF and differential response to diuretic therapy, which was associated with length of stay and mortality.
Study context
- Population
- Patients with acute decompensated HF from pooled trials (derivation ROSE-AHF, CARRESS-HF, ATHENA-HF; validation DOSE/ESCAPE)derivation cohort
- Participants
- 794 patients
- Comparison
- Diuretic efficiency phenogroups; BAN-ADHF score
- Phenogroup 1n = 370
- Phenogroup 2n = 290
- Phenogroup 3n = 134reference
- Outcome
- Diuretic efficiency (urine output over first 72 h per total IV furosemide-equivalent loop diuretic dose)
- Follow-up
- First 72 hours
Performance
As reported in the abstract
Diuretic efficiency by phenogroup
P < 0.001
Further findings
| Outcome | median urine output difference (mL/d) |
|---|---|
| Urine output with 80 mg IV twice-daily furosemide | 3,520 |
BAN-ADHF score prediction of lowest diuretic efficiency phenogroup
- C-index (DOSE/ESCAPE validation cohort)
- 0.92
- Superior to creatinine, blood urea nitrogen, natriuretic peptides or home diuretic dose (DeLong)
- P < 0.001
Net urine output with 80 mg IV twice-daily furosemide, BAN-ADHF score 5 vs 20 · 24 hours
mL per 24 hours
- Low (5) BAN-ADHF score
- 2,650
- High (20) BAN-ADHF score
- 660
Higher BAN-ADHF score and clinical outcomes
- Significantly lower global well-being, higher discharge natriuretic peptides, longer in-hospital stay and higher in-hospital mortality risk in derivation and validation cohorts
Original publication
A Phenomapping Tool and Clinical Score to Identify Low Diuretic Efficiency in Acute Decompensated Heart Failure. JACC Heart Fail. Published 13 December 2023. doi:10.1016/j.jchf.2023.09.029
Summarised from the published abstract; every number is checked against it