Hubungan antara GWTG-HF (Get With The Guideline-Heart Failure) Risk Score dengan Kejadian Kardiovaskular Mayor pada pasien dengan Gagal Jantung Akut selama masa rawatan di RS Adam Malik Medan

Abstract

Background: Heart failure (HF) is a health problem with a prevalence of 64 million people worldwide. HF is associated with high mortality and morbidity rates, poor quality of life, and places a great burden on the health care system. Acute Heart Failure (AHF) is a condition that requires immediate treatment and has a high risk of mortality and Major Cardiovascular Events (MACE). The Get With The Guideline (GWTG) Score has been developed as a mortality risk prediction tool in emergency heart failure patients in emergency health care units. The GWTG score was initially used as a risk stratification tool and to assess the mortality risk, but several other studies have shown that this score can also predict MACE in the AHF population. However, the relationship between the GWTG Score and MACE in AHF patients in Indonesia still needs to be studied further.

Method: This study is a retrospective observational cohort design with a sample of AHF patients at Adam Malik General Hospital Medan from January 2024 to March 2025. Data were collected and analyzed on patient characteristics, GWTG score assessment, and observation of MACE during treatment. Statistical analysis was performed using ROC curves and multivariate analysis.

Results: The total number of study subjects was 319 people. The average age was 55 years. Most of the subjects were male, 174 patients (54.5%). The shortest length of treatment was 1 day and the longest was 47 days, with a median of 5 days. The most common characteristics of AHF were ADHF with 210 patients (65.8%). The most common etiology of AHF was infection with 149 patients (46.7%). A total of 166 patients (52.0%) had HFrEF. The most common risk factors and comorbidities were coronary heart disease 199 (62.4%) and smoking 162 (50.8%). During treatment, the most common MACE was mortality with 60 patients (18.8%). MACE based on GWTG score categories were Low 10 (8.1%), Moderate 15 (17.4%), and High 40 (36.7%). The incidence of MACE increased in line with higher GWTG scores. Age, Systolic Blood Pressure, Heart Rate, Natrium and BUN had a significant influence on MACE with a p-value <0.05. The results showed that the GWTG score has a significant predictive value for the occurrence of MACE with an AUC value of 0.759 and a p-value of 0.000, Sensitivity 63.2% and Specificity 78.1%

Conclusion: There is a significant relationship between GWTG score with MACE, indicating that GWTG score can be used as a predictive tool for MACE risk in AHF patients. The use of this score can assist in clinical decision making and improve patient management.