Abstract 11631: Risk Score for Prognosis in Patients with Systolic Heart Failure and Mild Symptoms, and the Impact of Eplerenone at Different Levels of Risk
Background: Our objective was to use EMPHASIS trial data to create a simple prognostic risk score for the composite endpoint (CEP) of cardiovascular death or hospitalisation for heart failure among patients with systolic heart failure and mild symptoms. We then assessed the efficacy of eplerenone across different categories of risk.
Methods: The Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure trial (EMPHASIS-HF) was an international randomised trial, comparing eplerenone with placebo in patients with systolic heart failure and mild symptoms. Multivariable Cox proportional hazards modelling was used to identify baseline risk factors for the CEP.
Results: In addition to age and sex, eight baseline variables (SBP, eGFR, diabetes, BMI, haemoglobin, prior HF hospitalisation, prior MI/CABG and heart rate) were found to be strong (p<0.0001) independent risk factors. Estimates from the model were converted into a simple integer risk score (ranging from 0 to 12) which was categorised into 3 groups of low (0-4), medium (5-6) and high (7-12) risk. In placebo patients, rates (per 100 patient years) for the CEP were 7.9, 19.4 and 44.4 in the low, medium and high risk groups respectively. On eplerenone, these rates were reduced to 5.4, 12.5 and 25.1 respectively. The hazard ratios (eplerenone versus placebo) were similar in the low (0.69, 95% CI 0.50 to 0.95), medium (0.64, 95% CI 0.49 to 0.84) and high-risk (0.58, 95% CI 0.44 to 0.76) categories. Consequently the absolute treatment benefit was greatest among those at highest risk.
Conclusions: This easy-to-use integer risk score should be of value in quantifying individual patient risk in patients with systolic heart failure and mild symptoms. The relative benefits of eplerenone appeared consistent across the whole spectrum of risk.
- © 2012 by American Heart Association, Inc.