Evaluation of the A2B Score for Prediction of Survival in Patients With Heart Failure in a Nationwide Cohort in Japan

Abstract

Background Although a tool for sharing patient prognosis among all medical staff is desirable in heart failure (HF) cases, only a few simple HF prognostic scores are available. We previously presented the A2B score, a simple user‐friendly HF risk score, and validated it in a small single‐center cohort. In the present study, we validated it in a larger nationwide cohort. Methods and Results We examined the 2‐year mortality in relation to the A2B scores in 3483 patients from a Japanese nationwide cohort and attempted to stratify their prognoses according to the scores. The A2B score was determined by assigning points for age, anemia, and brain natriuretic peptide (BNP) level at discharge: age (<65 years, 0; 65–74 years, 1; ≥75 years, 2), anemia (hemoglobin ≥12 g/dL, 0; 10–11.9 g/dL, 1; <10 g/dL, 2), and BNP (<200 pg/mL, 0; 200–499 pg/mL, 1; ≥500 pg/mL, 2). Hemoglobin and BNP levels were applied to the data at discharge. The 2‐year survival rates for A2B scores 1, 2, 3, 4, 5, and 6 were 94.1%, 83.2%, 74.1%, 63.5%, 51.6%, and 41.5%, respectively; the mortality rate increased by ≈10% for each point increase (c‐index, 0.702). The A2B score was applicable in HF cases with reduced or preserved ejection fraction and remained useful when BNP was substituted with N‐terminal proBNP (c‐index, 0.749, 0.676, and 0.682, respectively). Conclusions The A2B score showed a good prognostic value for HF in a large population even when BNP was replaced with N‐terminal proBNP.

Keywords

• heart failure
• prognosis
• risk score model