Tool may help accurately predict 30-day mortality for emergency department patients with acute heart failure

1. Based on 13 independent risk factors that are available at most emergency department (ED) admissions, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with Acute Heart Failure) score was able to accurately predict 30-day mortality in ED patients with AHF, particularly those at very high or low risk.

2. Using this tool may especially be of use in identifying ED patients with AHF at very high or low risk of 30-day mortality, which can be important for treatment management decisions.

Evidence Rating Level: 2 (Good)       

Study Rundown: Every year in the United States and Europe, over 1 million hospitalizations result from AHF. About 90% of these patients go to the ED. Decisions made in the ED are crucial, but no stratification of patients by risk occurs during this process. Although there are AHF risk scores available, a more dependable tool is necessary. This prospective cohort study sought to predict mortality data based on information available from ED admission. Using 13 independent risk factors found in the derivation cohort, researchers combined them into an overall score named the MEESSI-AHF score. The outcomes were tested again with a validation cohort. The tool was shown to be able to accurately predict 30-day mortality risk for these patients. ED physicians may take this tool (which includes an online calculator for ease of use) into consideration to assist with clinical decisions. Further studies can help reveal whether or not this tool improves clinical choices and patient outcomes.

A strength of the study is that the 13 predictors identified are normally available in worldwide routine clinical practice. Limitations of the study include use of EDs in a single country, non-random ED selection, patients with missing data, and subjectivity of some risk factor measurements.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Predicting mortality among patients hospitalized for heart failure: Derivation and validation of a clinical model

In-Depth [prospective cohort]: The Epidemiology of Acute Heart Failure in Emergency Departments (EAHFE) registry collects information on patients with a final AHF diagnosis at 34 Spanish EDs. The derivation cohort was comprised of 4867 AHF patients who were admitted to the ED during 2009 to 2011. Using a logistic regression model, researchers identified 13 independent predictors of mortality: Barthel index score at admission, systolic blood pressure, age, N-terminal pro–B-type natriuretic peptide level, potassium level, positive troponin level, New York Heart Association class IV disease at admission, respiratory rate, low-output symptoms, oxygen saturation, episode associated with acute coronary syndrome, hypertrophy on electrocardiography, and creatine level. The validation cohort included 3229 AHF patients who were admitted to the ED during 2014. The MEESSI-AHF score was able to predict 30-day mortality with good discrimination and calibration, especially in patients at very high (10% of patients, ~45% risk) or low risk (40% of patients, <2% risk) of death in 30 days. Identifying these groups may be important in treatment management.

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