Assessment of the Accuracy of the ADHERE Score in a Brazilian Acute Heart Failure Cohort

Background  Patients hospitalized for acute heart failure present a high mortality rate, so risk stratification for in-hospital death is of utmost importance. Risk scores can help physicians to identify patients at higher risk, but it is important to validate those scores in different populations, since sociodemographic characteristics may be very heterogeneous.

Objectives  This study aimed to evaluate the ADHERE (Acute Decompensated Heart Failure Registry) risk score in a Brazilian quaternary teaching care center.

Methods  This was a retrospective cohort study involving 304 patients with acute heart failure aged ≥ 18 years old, conducted between September 2019 and July 2022. The primary endpoint was the evaluation of the ADHERE score by analysis of the discriminatory index and classification. The secondary endpoint was the evaluation of other prognostic factors for in-hospital mortality. A p-value < 0.05 was considered statistically significant.

Results  ADHERE score presented a discriminatory index of 0.69. ADHERE classification index was suboptimal, since the score did not stratify mortality risk on five strata as proposed originally. Furthermore, the score underestimates risk in the studied population. Admission serum urea was the only isolated prognostic factor for the endpoint (OR 1.043; CI 95% 1.024-1.062; p<0.001).

Conclusion  The ADHERE risk score cannot be entirely validated in our cohort, since classification was not achieved despite an ideal discriminatory index. Admission serum Urea was the only independent risk factor associated with in-hospital mortality. Our study emphasizes the importance of correct external validation of a prognostic score, especially if the demographic and clinical characteristics of cohorts are not comparable.

Keywords
Heart Failure; Prognosis; Mortality

Central Illustration:
Assessment of the Accuracy of the ADHERE Score in a Brazilian Acute Heart Failure Cohort