Predicting Outcomes Over Time in Patients With Heart Failure, Left Ventricular Systolic Dysfunction, or Both Following Acute Myocardial Infarction.
Abstract
BACKGROUND: Most studies of risk assessment or stratification in patients with myocardial
infarction (MI) have been static and fail to account for the evolving nature of clinical
events and care processes. We sought to identify predictors of mortality, cardiovascular
death or nonfatal MI, and cardiovascular death or nonfatal heart failure (HF) over
time in patients with HF, left ventricular systolic dysfunction, or both post-MI.
METHODS AND RESULTS: Using data from the VALsartan In Acute myocardial iNfarcTion
(VALIANT) trial, we developed models to estimate the association between patient characteristics
and the likelihood of experiencing an event from the time of a follow-up visit until
the next visit. The intervals are: hospital arrival to discharge or 14 days, whichever
occurs first; hospital discharge to 30 days; 30 days to 6 months; and 6 months to
3 years. Models were also developed to predict the entire 3-year follow-up period
using baseline information. Multivariable Cox proportional hazards modeling was used
throughout with Wald chi-squares as the comparator of strength for each predictor.
For the baseline model of overall mortality, the 3 strongest predictors were age (adjusted
hazard ratio [HR], 1.35; 95% CI, 1.28-1.42; P<0.0001), baseline heart rate (adjusted
HR, 1.17; 95% CI, 1.14-1.21; P<0.0001), and creatinine clearance (≤100 mL/min; adjusted
HR, 0.86; 95% CI, 0.84-0.89; P<0.0001). According to the integrated discrimination
improvement (IDI) and net reclassification improvement (NRI) indices, the updated
model had significant improvement over the model with baseline covariates only in
all follow-up periods and with all outcomes. CONCLUSIONS: Patient information assessed
closest to the time of the outcome was more valuable in predicting death when compared
with information obtained at the time of the index hospitalization. Using updated
patient information improves prognosis over using only the information available at
the time of the index event.
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https://hdl.handle.net/10161/15032Published Version (Please cite this version)
10.1161/JAHA.115.003045Publication Info
Lopes, Renato D; Pieper, Karen S; Stevens, Susanna R; Solomon, Scott D; McMurray,
John JV; Pfeffer, Marc A; ... Velazquez, Eric J (2016). Predicting Outcomes Over Time in Patients With Heart Failure, Left Ventricular Systolic
Dysfunction, or Both Following Acute Myocardial Infarction. J Am Heart Assoc, 5(6). 10.1161/JAHA.115.003045. Retrieved from https://hdl.handle.net/10161/15032.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Renato Delascio Lopes
Professor of Medicine
Atrial Fibrillation Antithrombotic Therapy in patients with Acute Coronary Syndromes
Elderly patients with Heart Disease Biomarkers in Acute Coronary Syndromes and Atrial
Fibrillation Thrombosis and Anticoagulation and novel antithrombotic agents Metabolomics
in Cardiovascular Medicine
Eric J. Velazquez
Adjunct Professor in the Department of Medicine
LeadershipEric J. Velazquez, MD, is a Professor of Medicine with tenure at Duke University.
As section chief for Cardiovascular Imaging in the Division of Cardiology and director
of the Cardiac Diagnostic Unit and Echocardiography Laboratories for Duke University
Health System, he coordinates a high-volume enterprise and an outstanding group of
clinician-investigators and clinical staff who make important contributions across
patient care, research and educational
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