Evaluation of the A 2 B 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 A 2 B 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 A 2 B scores in 3483 patients from a Japanese nationwide cohort and attempted to stratify their prognoses according to the scores. The A 2 B 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 A 2 B 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 A 2 B 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 A 2 B score showed a good prognostic value for HF in a large population even when BNP was replaced with N‐terminal proBNP.