A biomarker profile discriminates acute HF from worsening HF
Acute heart failure as a distinctive disorder: an analysis from BIOSTAT-CHF
HFA Discoveries 2020 webinar presented by Stefanie Senger (Durham, NC, USA)
Introduction and methods
Acute heart failure (AHF) is defined as worsening of symptoms and signs of HF requiring urgent care. Series of neutral trials on evaluation of new AHF interventions resulted in doubts whether AHF is a separate condition or part of chronic HF. Admission of AHF remains subjective as there are no objective measures to determine if a patient has AHF.
This study aimed to identify markers to distinguish between AHF and worsening HF (WHF) managed in outpatient clinics (outpatients with WHF; OP-WHF) and determined whether predictors of clinical outcomes differ between the two groups.
BIOSTAT-CHF (A Systems Biology Study to Tailored Treatment in Chronic Heart Failure) study enrolled patients with AHF requiring hospital admission or with WHF in outpatient clinics. BIOSTAT-CHF consists of an index cohort of 2516 patients (67% inpatients and 33% outpatients) with new or worsening HF symptoms and a validation cohort of 1738 patients (54% inpatients vs. 46% outpatients) with HF diagnosis and previous admission of HF. A model with input of patient characteristics, central laboratory measurements, special biomarkers, and proteomic results (4 Olink panels) was generated.
- Final model contained age, LVEF, DBP, heart rate, albumin, phosphate, NT-proBNP, tropine I and 21 out of 50 selected Olink markers (including MUC-16). Discriminative value of this model was excellent with C-index (AUC) 0.91 in the index cohort and 0.90 in the validation cohort.
- All-cause death and HF re-admission at day 180 were higher in inpatients compared to outpatients, but overall, event rate was quite low.
- Two different models were generated for outcome of all-cause death at day 180 for inpatients and outpatients, with C-index 0.83 for inpatients and 0.85 for outpatients.
- Two different models were generated for HF re-admission at day 180 for inpatients and outpatients, with C-index 0.73 for inpatients and 0.82 for outpatients. There was more overlap in markers in these models for HF re-admission.
In this analysis using data from BIOSTAT-CHF, higher rates for all-cause death and HF re-admission were observed for inpatients compared to OP-WHF patients. Furthermore, a biomarker profile was identified to discriminate between patient status. Prognostic models for outcomes of all-cause death and HF re-admission differed between patient status. The authors suggest that there are different pathophysiological mechanisms leading to different patterns of activation of neurohormonal and inflammatory protein markers in AHF.
- Our reporting is based on the information provided at HFA Discoveries-