Clinical Research & Data
Predicting Survival in Patients with Acute Decompensated Heart Failure and Cardiogenic Shock
Acute decompensated heart failure (ADHF) patients with cardiogenic shock (CS) differ from acute myocardial infarction (AMI) shock patients. “They differ in their acuity of presentation, they differ in important prognostic markers,” explains Rashad Garan, MD, senior author of the 2021 publication titled, “Predicting survival in patients with acute decompensated heart failure complicated by cardiogenic shock.”
“Recognizing that a lot of the risk scores, a lot of the prior work has been focused on AMI-related shock,” Dr. Garan emphasizes, “the focus with this work is to try to understand the patient population with decompensated heart failure-related shock and what are the predictors here that drive outcomes so that we can risk stratify patients, really from the moment we’re seeing them upon presentation.”
Dr. Garan explains that the first author of the paper, Nuccia Morici, MD, in Milan, Italy, spearheaded this work, developing the ALC-Shock score, based on three parameters (age, serum lactate, and serum creatinine) to predict survival or successful bridge to heart replacement therapy at 28-day follow-up in patients with ADHF-CS. The score was then validated in a separate cohort of ADHF-CS patients in New York and compared to the CardShock risk score.
Dr. Garan states that the model studied had good discriminatory capability in terms of identifying patients as low, intermediate, or high risk. “We were happy with the results, at least as far as being able to identify low- and moderate-risk patients, as opposed to high-risk patients. What we saw in the validation cohort was that the ability to predict outcomes for high-risk patients in that cohort was less robust than it was in the derivation cohort.” He notes that it was a retrospective design and that one would expect there to be some differences when using one cohort to derive and one cohort to validate.
“And so I think the value of a score like the ALC-shock score,” Dr. Garan concludes, “is really being able to focus on patients with decompensated heart failure and to be able to risk stratify that patient population in particular as opposed to a more heterogeneous patient population with multiple etiologies of shock analyzed together.”