Admission NT-proBNP provides stronger prognostic discrimination than the AHEAD score for 1-year mortality in hospitalized acute heart failure: A retrospective cohort study

BACKGROUND: Both admission N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the AHEAD score predict prognosis in acute heart failure, but their comparative and complementary value for admission risk stratification remains uncertain. METHODS: We screened 512 consecutive adult hospitalizations for acute heart failure; 478 records had sufficient baseline data, and 430 patients had ascertainable 1-year vital-status follow-up and constituted the analytic cohort. We compared admission NT-proBNP (log-transformed) with the AHEAD score for 1-year all-cause mortality using Cox models, Harrell C-index, apparent calibration, and reclassification (continuous net reclassification improvement [NRI] and integrated discrimination improvement [IDI]). A combined model of both markers and a combined AHEAD x NT-proBNP stratification were also evaluated. RESULTS: During 1 year, 84 deaths (19.5%) occurred. ln(NT-proBNP) was strongly associated with mortality (adjusted HR 2.63, 95% CI 2.05-3.37 per 1-unit increase; approximately HR 1.95 per doubling). AHEAD categories were associated with mortality in univariable analysis (HR 1.95 for score 2 and 3.61 for score ≥ 3 vs 0-1), but were attenuated after adjustment for ln(NT-proBNP) and admission covariates (adjusted HR 1.03 and 1.81). ln(NT-proBNP) showed higher discrimination than AHEAD categories (Harrell C-index 0.758 vs 0.608). The combined model improved discrimination and reclassification compared with AHEAD alone (C-index 0.757; Delta C-index 0.150; continuous NRI 0.840; IDI 0.136), but not compared with ln(NT-proBNP) alone (Delta C-index 0.000). In combined stratification, the highest NT-proBNP tertile (T3; > 6,385 pg/mL) identified high-risk groups regardless of AHEAD category. CONCLUSIONS: In hospitalized acute heart failure, admission NT-proBNP provided stronger prognostic discrimination than AHEAD categories for 1-year mortality in this cohort. AHEAD may still provide complementary clinical context, but adding AHEAD to ln(NT-proBNP) did not materially improve discrimination beyond NT-proBNP alone. External validation is warranted.