Introduction
It has been estimated that there are at least 23 million people with
heart failure (HF), making it one the most common cardiovascular
disorders in the contemporary age [1]. Despite the advances in the
screening, diagnosis and management of HF; mortality rates remain high,
with a rate of 121 per 1000 patient years for patients with preserved
ejection fraction (HFpEF) and 141 per 1000 patients for patients with a
reduced ejection fraction (HFrEF) [2]. While clinical judgement and
individual parameters are commonly employed for prognostication,
multiple risk models are also available to estimate mortality and to
guide management decisions [3-7]. A common issue with these risk
models is that they generally suffer from “overfitting” of multiple
redundant variables that are not useful in estimating prognosis in other
HF cohorts where mortality rate is different from the original
derivation cohort [8]. Moreover, the necessity of using numerous
(and sometimes laborious to obtain) variables to calculate a single risk
score for each HF patient usually renders these scores impractical for
clinical use in a busy clinic. Age, creatinine and ejection fraction
(ACEF) score was initially developed to predict postoperative mortality
after cardiovascular surgery, while keeping the “law of parsimony” in
mind [8]. However, later studies have found the ACEF score or its
simple modifications - such as the ACEF-MDRD score - were useful to
predict mortality or complications following percutaneous coronary or
structural interventions, as well as those who had acute coronary
syndromes [9-12]. Individual variables used to calculate ACEF score
have already been shown as predictors of hospitalizations and mortality
in patients with HF, and it is reasonable to consider that a score
calculated using these variables would have better usefulness to predict
mortality in HF [13-16]. In the present analysis, we sought to
investigate whether ACEF-MDRD score could predict one-year mortality in
HF patients, and to understand how ACEF-MDRD score compares to other
established but more complex models, such as the Get With The Guidelines
- Heart Failure (GWTG-HF) score.