Clinical Outcome Predictor using Killip Scoring in Acute Decompensated Heart Failure (ADHF): A Non-Cardiac Centre Pilot Experience

Ling, Hwei Sung and Chung, Joshua Bui Khiong and Chua, Pin Fen and Gan, Kai Xin and Ong, Elora Yoke Ling and How, Wai Leng and Kueh, Cindy Hui San and Chin, Yie Ping and Fong, Alan Yean Yip (2018) Clinical Outcome Predictor using Killip Scoring in Acute Decompensated Heart Failure (ADHF): A Non-Cardiac Centre Pilot Experience. International Journal of Cardiology, 273. pp. 1-13.

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Abstract

Background: Physicians in tertiary centers face a constant challenge in selecting patient with ADHF to be admitted from district healthcare centre, especially with limited resources. Appropriate risk stratification of patients with ADHF would improve the efficiency of our healthcare delivery system. Objective: We aim to find potential relationship between Killip clinical scoring with clinical outcome of ADHF, including in-patient mortality and requirement of advanced cardiorespiratory support. Methods: 35 consecutive cases with a discharge diagnosis of ADHF and admission creatinine clearance of more than 30 were randomly reviewed. Cases were analyzed retrospectively for their Killip score, in-patient mortality, requirement of advance cardiorespiratory care or ICU admission. Results: There were 21 male patients (60%) and 14 female patients. Mean age was 61±19 years old. Mean duration of ward-stay was 6±4 days. Comorbidities were 14 (40%) with history of coronary artery diseases and 17 (49%) with diabetes mellitus. 15 patients (43%) were on at least a single type of guideline directed medication for heart failure. The cohort was almost evenly distributed between those with a Killip score of 2 and above 2. A Killip score of 3 and above was found to have good positive predictive value (87%) for advanced cardio-respiratory care and negative predictive value of 78%. No in-patient death was observed for the group with Killip 2 while 5 deaths were recorded in the group scoring more than 2. A Killip score of 3 had excellent (100%) negative predictive value for in-patient mortality but poor positive predictive value (33%). Significant relationship (p<0.001) was observed for Killip scoring on both outcomes. Conclusion: Killip scoring may be useful for on-call physician to decide the need on tertiary care among patient with ADHF and mortality outcome. However, more prospective studies and patients should be recruited to validate the study.

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