Published Online
on October 22, 2009

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Original Article

A Multidimensional Prognostic Index (MPI) Based on a Comprehensive Geriatric Assessment Predicts Short-Term Mortality in Older Patients with Heart Failure.

Alberto Pilotto^1,8; Filomena Addante¹; Marilisa Franceschi¹; Gioacchino Leandro²; Giuseppe Rengo³; Piero D'Ambrosio¹; Maria Grazia Longo¹; Franco Rengo⁴; Fabio Pellegrini⁵; Bruno Dallapiccola⁶ and Luigi Ferrucci⁷

¹ IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, Italy;
² IRCCS "Saverio De Bellis," Castellana Grotte, Italy;
³ U Federico II, Naples; Scientific Inst of Telese Terme, Italy; Thomas Jefferson U, Philedelphia, PA;
⁴ University Federico II, Naples, Italy;
⁵ Consorzio Mario Negri Sud, S. Maria Imbaro, Italy;
⁶ Casa Sollievo della Sofferenza-Mendel Institute and U "La Sapienza," Rome, Italy;
⁷ National Institute on Aging, Baltimore, MD

^* Corresponding author; email: lisa.franceschi{at}alice.it

Background—Multidimensional impairment of older patients may influence the clinical outcome of diseases. Aim of study was to evaluate whether a Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment (CGA) predicts short-term mortality in older patients with heart failure (HF).

Methods and Results—In this prospective study with a one-month follow-up, 376 patients aged 65 and older with a diagnosis of HF were enrolled. A standardized CGA that included information on functional (Activities of Daily Living, ADL and Instrumental-ADL), cognitive (Short Portable Mental Status Questionnaire) and nutritional status (Mini Nutritional Assessment), as well as on risk of pressure sore (Exton-Smith Scale), comorbidities (CIRS Index), medications and social support network was used to calculate the MPI for mortality using a previously validated algorithm. The New York Hearth Association (NYHA), the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) and the Acute Decompensated Heart Failure National Registry (ADHERE) regression model scores were also calculated. Higher MPI values were significantly associated with higher 30-day mortality both in men (MPI-1=2.8%, MPI-2=15.3%; MPI-3=47.4%; p=0.000) and women (MPI-1=0%, MPI-2=6.5%; MPI-3=14.6%; p=0.011). The discrimination of the MPI was also good, with areas under the ROC curves (men= 0.83 95%CI 0.75-0.90, women=0.80 95%CI 0.71-0.89) greater than ROC areas of NYHA (men=0.63, 95%CI 0.57-0.69, p=0.015; women=0.65, 95%CI 0.55-0.75, p=0.064), EFFECT (men=0.69, 95%CI 0.58-0.79,p=0.045; women=0.71, 95%CI 0.55-0.87, p=0.443) and ADHERE scores (men=0.65, 95%CI 0.52-0.78,p=0.023; women=0.67, 95%CI 0.49-0.83,p=0.171).

Conclusions—The MPI, calculated from information collected in a standardized CGA, is useful to estimate the risk of 1 month mortality in older patients with HF.

Key Words: heart failure • mortality • prognosis • risk factors • Multidimensional prognostic index (MPI)