Applicability of GWTG Score to Heart Failure Patients in South India

Abstract

Abstract Background The get with the guidelines (GWTG) risk score was developed to predict in-hospital mortality in acute heart failure patients. We aimed to clarify the prognostic impacts of the GWTG risk score in the south Indian heart failure patients admitted to intensive cardiac care unit (ICCU) in our hospital. Aim Our primary aim was to see the applicability of predicted GWTG risk score of heart failure in the south Indian heart failure patients admitted to intensive cardiac care unit (ICCU) of our hospital. Our secondary aim was to see the event rates and correlate predicted GWTG risk score of heart failure with in-hospital complications. Materials and Methods We included all the patients admitted to ICCU with the diagnosis of either ischemic or dilated cardiomyopathy over 6 months (January 2018 to June 2018). Indication for admission was either symptomatic heart failure (HF) or to evaluate cause for heart failure. We recorded the demographic and clinical parameters along with the ECG, 2D echo features, and relevant laboratory investigations. The GWTG risk score was based on seven parameters. Race, age, systolic blood pressure, heart rate, blood urea nitrogen (BUN) level, sodium concentration, and presence of chronic obstructive pulmonary disease (COPD) were used to predict in-hospital all-cause mortality, and in-hospital complications were noted. Results Out of 130 patients, 97 patients fulfilled the inclusion criteria. Out of them, 65 were males, with most of the patients between 40 to 80 years of age. Half the patients were diabetic and had abnormal electrocardiogram (ECG), and more than half were hypertensive, had clinically left ventricular failure (LVF) and diagnosed with ischemic cardiomyopathy (ICMP). Very few were smokers, and < 30% were alcoholics, had abnormal liver function tests (LFT) and diagnosed with dilated cardiomyopathy (DCMP). Patients were divided into ICMP and DCMP patients, and all the variables were compared. Low systolic blood pressure (BP), abnormal ECG and the mean of GWTG score were greater in 22 patients afflicted with DCMP. However, abnormal renal functions with anemia and more NT-pro-brain natriuretic peptide (NT-proBNP) elevations were observed in ICMP HF patients. Out of 97 patients 70% patients had GTWG score of 34 to 50. There were no patients with score > 58 in our study. Eighteen patients showed in-hospital complications. Five patients died with mean GWTG score 45.00, and they experienced cardiogenic shock with tachycardia and severe LV dysfunction (ejection fraction [EF] < 15%), renal failure, hyponatremia, NT-proBNP levels > 25,000 pg/dl and hepatic derangement at admission. A total of 92 patients were discharged with 39.02 mean GWTG score. There was a significant difference between the mean GWTG scores of patients in their final status (discharged/death) (p = 0.040). Also, patients with in-hospital complications had higher GWTG values (on an average 7 scores higher) than without complications (p = 0.000). Conclusions GWTG scores were able to predict (with statistical significance) the true end results for both complications during hospitalization and final discharge/death in hospitalized Indian HF patients. Higher GWTG Scores were an indication of complications or death (39 for complications and 45 for death seems to be the possible average values).