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Acute Heart Failure and 30-Day Mortality
Study Questions:
How can emergency room physicians risk stratify patients with acute heart failure (AHF)?
Methods:
The EAHFE (Epidemiology of Acute Heart Failure in Emergency Departments) Registry was formed in 34 Spanish emergency departments, which saw patients with a diagnosis of AHF. Prespecified criteria established the diagnosis of AHF. Note that patients were excluded with AHF due to ST-segment elevation myocardial infarction. Data were collected on each patient with this diagnosis. A model that would risk stratify these patients was developed and named MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score in Patients with AHF). Patients admitted from May 2009-December 2011 were enrolled into a derivation cohort, while patients admitted from January-February 2014 were enrolled into the validation cohort. The derivation cohort was used to predict a 30-day mortality risk model and the validation cohort was used to test this model.
Results:
The derivation cohort compromised 4,897 patients. Mean age was 79.7 years, and 57.1% were female. A total of 89.5% had New York Heart Association class III/IV symptoms and 41.5% had a left ventricular ejection fraction <0.50; 75.6% of patients were hospitalized, with a median length of stay of 7 days; and 10.3% died within 30 days of admission. A logistic regression model identified 13 independent predictors of death that were included in the MEESSI-AHF score. The risk score was validated in a cohort of 3,220 patients in January-February 2014. A total of 9.26% died within 30 days of admission. The model fit and extent of risk discrimination were similar in both cohorts.
Conclusions:
The MEESSI-AHF risk score may be used to risk stratify patients with AHF in the emergency department; assisting physicians to identify patients at highest risk for mortality from AHF.
Perspective:
As we globally focus on ways to decrease HF hospitalizations, this single-country study was able to develop a tool to risk stratify patients with AHF in the ED. There are limited risk stratification tools that have been externally validated and developed for patients seen in the emergency department with AHF. Ultimately we need to determine if risk stratification tools, such as the MEESSI-AHF risk score, will improve outcomes for HF patients.
Keywords: Acute Disease, Emergency Service, Hospital, Geriatrics, Heart Failure, Hospital Mortality, Length of Stay, Risk, Stroke Volume
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