Effectiveness Analysis of The I NEED HELP Scale For Prognostic Evaluation of Heart Transplant Waiting List Patients

Aim    To evaluate the efficacy of the I NEED HELP scale in determining the six-month prognosis for patients on the heart transplant waiting list (HTWL) of the Almazov National Medical Research Center of the Russian Ministry of Health.
Material and methods    This retrospective study included 42 patients from the HTWL. The patients’ survival for more than 6 months was assessed. The composite end point (CEP) of adverse outcome was all-cause death, heart transplantation (HT) due to the increased urgency of surgical intervention according to UNOS within 6 months after the inclusion in the HTWL. Patients were evaluated using the I NEED HELP scale. Statistical analysis was performed by nonparametric methods.
Results    The median I NEED HELP score was 4 [from 1 to 7]. The increase in score was positively correlated with the incidence of adverse outcomes (r=0.5; p=0.0007). The group of patients with an unfavorable outcome had a median score higher by one than for the survivors (score 5 vs. 4, respectively; p=0.001). The greatest effect on the prognosis was exerted by low systolic blood pressure (SBP) (p=0.003); the failure to increase or the necessity to decrease the doses of disease-modifying drugs (p=0.039); and target organ dysfunction (p=0.039). The sensitivity and specificity of the scale at a score 5 or higher were 100% and 84%, respectively.
Conclusion    This pilot study demonstrated the efficacy of the I NEED HELP scale in a patient population from a specialized center HTWL with high sensitivity and specificity at the determined threshold score 5 for an unfavorable outcome. It is appropriate to continue the study with an expanded sample and validation of the scale on patient cohorts from hospitals of various healthcare system levels.

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