Admission NT-proBNP Outperforms AHEAD Score for 1-Year Mortality Prediction in Acute Heart Failure

Accurate risk stratification for acute heart failure (AHF) patients upon hospital admission is crucial for guiding treatment and improving outcomes. Both N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the AHEAD score are established prognostic markers. However, their comparative and complementary utility for predicting 1-year mortality in AHF patients has remained uncertain, leading to a gap in optimized admission risk assessment protocols. Understanding which marker, or combination, offers superior predictive power could refine clinical decision-making.

Researchers conducted a retrospective cohort study screening 512 consecutive adult hospitalizations for acute heart failure. The analytic cohort comprised 430 patients with sufficient baseline data and ascertainable 1-year vital status. They compared admission ln(NT-proBNP) (log-transformed) with the AHEAD score for predicting 1-year all-cause mortality using Cox models. Discrimination was assessed via Harrell C-index, apparent calibration, and reclassification using continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). A combined model of both markers and a combined AHEAD x NT-proBNP stratification were also evaluated.

Over a 1-year period, 84 deaths occurred, representing 19.5% of the cohort. ln(NT-proBNP) was strongly associated with mortality, showing an adjusted HR 2.63 (95% CI 2.05-3.37) per 1-unit increase, equating to approximately HR 1.95 per doubling. While AHEAD categories were associated with mortality in univariable analysis (HR 1.95 for score 2 and 3.61 for score ≥ 3 vs 0-1), these associations were attenuated after adjustment for ln(NT-proBNP) and admission covariates (adjusted HR 1.03 and 1.81).