Prediction of recurrent heart failure hospitalizations and mortality using the echocardiographic Killip score.

ABSTRACT

AIM: Examine the performance of a simple echocardiographic "Killip score" (eKillip) in predicting heart failure (HF) hospitalizations and mortality after index event of decompensated HF hospitalization. METHODS: HF patients hospitalized at our facility between 03/2019-03/2021 who underwent an echocardiography during their index admission were included in this retrospective analysis. The cohort was divided into 4 classes of eKillip according to stroke volume index (SVI) < 35ml/m2 > and E/E' ratio < 15 > . An eKillip Class I was defined as SVI ≥ 35ml/m2 and E/E' ≤ 15 and was used as reference. RESULTS: Included 751 patients, median age 78.1 (IQR 69.3-86) years, 59% men, left ventricular ejection fraction 45 (IQR 30-60)%, brain natriuretic peptide levels 634 (IQR 331-1222)pg/ml. Compared with eKillip Class I, a graded increase in the combined endpoint of 30-day mortality and rehospitalizations rates was noted (Class II HR 1.77, CI 0.95-3.33, p = 0.07; Class III HR 1.94, CI 1.05-3.6, p = 0.034; Class IV HR 2.9, CI 1.64-5.13, p < 0.001 respectively), which overall persisted after correction for clinical (Class II HR 1.682, CI 0.9-3.15, p = 0.105; Class III HR 2.104, CI 1.13-3.9, p = 0.019; Class IV HR 2.74, CI 1.54-4.85, p = 0.001 respectively) or echocardiographic parameters (Class II HR 1.92, CI 1.02-3.63, p = 0.045; Class III HR 1.54, CI 0.81-2.95, p = 0.189; Class IV HR 2.04, CI 1.1-3.76, p = 0.023 respectively). Specifically, the eKillip Class IV group comprised one-third of the patient population and persistently showed increased risk of 30-day HF hospitalizations or mortality following multivariate analysis. CONCLUSION: A simple echocardiographic score can assist identifying high-risk decompensated HF patients for recurrent hospitalizations and mortality.