Clinical Scorecard: Development of a Multimorbidity Risk Assessment Tool for Heart Failure Rehospitalization and Mortality: Incorporating Gut Microbiome Factors

At a Glance

Key Highlights

• An 11-variable risk model was developed incorporating age, previous HF hospitalization, NYHA class III/IV, NT-proBNP, diastolic blood pressure, loop diuretic use, beta-blocker non-use, creatinine, COPD, diabetes, and combined gut microbiome metabolites.
• The risk model demonstrated good diagnostic performance (C-statistic ~0.70) for predicting 1-year mortality and/or rehospitalization due to HF.
• A simple clinical risk score calculator stratifies patients into low-, mid-, and high-risk groups with significantly different outcomes, highlighting the added value of including gut microbiome factors.

Guideline-Based Recommendations

Diagnosis

• Incorporate assessment of traditional cardiovascular markers (e.g., NT-proBNP) alongside evaluation of comorbidities including COPD and diabetes.
• Consider measurement of gut microbiome metabolites (e.g., TMAO, acetyl-L-carnitine) as part of risk stratification in HF patients.

Management

• Optimize guideline-directed medical therapy including beta-blockers and loop diuretics, noting that beta-blocker non-use is associated with higher risk.
• Address comorbid conditions such as COPD and diabetes to potentially improve HF outcomes.

Monitoring & Follow-up

• Use the multimorbidity risk score to monitor patient risk over time and guide intensity of follow-up and interventions.
• Monitor biomarkers including NT-proBNP and renal function (creatinine) regularly.

Risks

• Higher risk of death or rehospitalization is associated with advanced age, prior HF hospitalization, worse NYHA class, elevated NT-proBNP, impaired renal function, presence of COPD and diabetes, and adverse gut microbiome metabolite profiles.

Patient & Prescribing Data

Hospitalized acute heart failure patients from two European cohorts

Beta-blocker non-use was identified as a risk factor; loop diuretic use was included in the model, emphasizing the importance of optimized pharmacotherapy in reducing rehospitalization and mortality risk.

Clinical Best Practices

• Incorporate multimorbidity assessment including gut microbiome metabolites into HF risk stratification.
• Use the developed 11-variable risk score calculator to categorize patients into risk groups for tailored management.
• Ensure comprehensive management of comorbidities alongside HF treatment to improve outcomes.
• Regularly monitor NT-proBNP, renal function, and clinical status to guide therapy adjustments.

References

• Editorial comment on multimorbid risk calculator in HF