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Screening tool predicts 30-day mortality in patients with acute HF

A risk stratification tool that uses readily available data accurately estimated the 30-day mortality risk for patients admitted to the ED with acute heart failure, according to data published in Annals of Internal Medicine.

“Although decision making in the ED is critically important, emergency physicians currently do not stratify patients by risk during this process,” Òscar Miró, PhD, from the emergency department of Hospital Clinic at the University of Barcelona, and colleagues wrote, adding that additional tools are needed to help physicians in the ED stratify patients with acute heart failure (HF) according to risk.

Researchers performed a prospective cohort study to estimate 30-day mortality of patients with acute HF using data from a registry comprised of 34 Spanish EDs. Miró and colleagues created their prediction tool model by selecting 13 prognostic variables and testing them against outcomes in a cohort of 4,867 consecutive ED patients admitted during 2009 to 2011.

Researchers additionally tested the outcomes in an independent validation population of 3,229 patients admitted to the same EDs in 2014. They selected readily available variables and developed an online calculator to make the tool easier for physicians to use.

In the derivation cohort, the prediction tool identified 13 independent risk factors, which were combined into an overall score known as MEESSI-AHF (multiple estimation of risk based on the emergency department Spanish score in patients with acute HF). The tool provided an accurate prediction of 30-day mortality risk, according to researchers. The score was especially useful for the 10% of patients at very high risk (around 45%) for death at 30 days, as well as for the 40% of patients at low risk (< 2%).

The results were confirmed in the validation cohort.

“Our study shows that physicians can use 13 readily available items to estimate individual risk for death within 30 days for patients with [acute] HF who are admitted to the ED,” Miró and colleagues wrote.

“We believe that physicians can consider using this tool to inform clinical decisions as we conduct further studies to determine whether the tool enhances physician decisions and improves patient outcomes,” they concluded, adding that the tool will be especially useful for identifying persons at lower risk, for whom further hospitalization may not be required.

In a related commentary, Peter S. Rahko, MD, from the University of Wisconsin School of Medicine and Public Health, wrote that other studies have aimed to create models that define ED prognosis among HF patients, yet none have gained acceptance. He explained that derivation methods can vary significantly because each model may have some nonintuitive variables to distinguish between high and low risk. Prospectively testing these models in diverse populations is key.

“If 40% of ED patients with HF are truly at very low risk, we must find commonalities among them. This information may guide development of an alternate infrastructure to successfully treat these patients out of the hospital,” Rahko wrote. “The vast diversity of medical care delivery across North America will necessitate unique innovation at almost every institution.” – by Savannah Demko

Disclosures: Miró reports receiving personal fees from Novartis outside the submitted work. Rahko reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.