Predicting the risk of reattendance for acute heart failure patients discharged from Spanish Emergency Department observation units

Background: The multiple estimation of risk based on the emergency department Spanish score in patients with acute heart failure (MEESSI-AHF) is a risk score designed to predict 30-day mortality in acute heart failure patients admitted to the emergency department. Using a derivation cohort, we evaluated the performance of the MEESSI-AHF risk score to predict 11 different short-term outcomes. Methods: Patients with acute heart failure from 41 Spanish emergency departments ( n=7755) were recruited consecutively in two time periods (2014 and 2016). Logistic regression models based on the MEESSI-AHF risk score were used to obtain c-statistics for 11 outcomes: three with follow-up from emergency department admission (inhospital, 7-day and 30-day mortality) and eight with follow-up from discharge (7-day mortality, emergency department revisit and their combination; and 30-day mortality, hospital admission, emergency department revisit and their two combinations with mortality). Results: The MEESSI-AHF risk score strongly predicted mortality outcomes with follow-up starting at emergency department admission (c-statistic 0.83 for 30-day mortality; 0.82 for inhospital death, P=0.121; and 0.85 for 7-day mortality, P=0.001). Overall, mortality outcomes with follow-up starting at hospital discharge predicted slightly less well (c-statistic 0.80 for 7-day mortality, P=0.011; and 0.75 for 30-day mortality, P<0.001). In contrast, the MEESSI-AHF score predicted poorly outcomes involving emergency department revisit or hospital admission alone or combined with mortality (c-statistics 0.54 to 0.62). Conclusions: The MEESSI-AHF risk score strongly predicts mortality outcomes in acute heart failure patients admitted to the emergency department, but the model performs poorly for outcomes involving hospital admission or emergency department revisit. There is a need to optimise this risk score to predict non-fatal events more effectively.

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The Emergency Department Arrival Mode and Its Relations to ED Management and 30-Day Mortality in Acute Heart Failure: An Ancillary Analysis From The EURODEM Study

10.21203/rs.3.rs-139434/v1 ◽

2021 ◽

Author(s):

Pia Harjola ◽

Tuukka TARVASMÄKI ◽

Cinzia BARLETTA ◽

Richard BODY ◽

Jean CAPSEC ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Emergency Medical Services ◽

Emergency Medical Service ◽

Acute Heart Failure ◽

Medical Service ◽

Ventilatory Support ◽

Medical Services ◽

Heart Failure Patients ◽

Emergency Medical

Abstract Background: Acute heart failure patients are often encountered in emergency departments from 11% to 57 % using emergency medical services. Our aim was to evaluate the association of emergency department arrival mode with acute heart failure patients’ emergency department management and short-term outcomes. Methods: This was a sub-analysis of the European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from 66 European emergency departments. Patients with emergency department diagnosis of acute heart failure were categorized into two groups: those using emergency medical services and those self-presenting (non- emergency medical service patients). The independent association between emergency medical services use and 30-day mortality was evaluated with logistic regression. Results: Of the 500 acute heart failure patients, 309 (61.8 %) arrived at emergency department by emergency medical services. They were older (median age 80 vs. 75 years, p<0.001) and had more dementia (18.7 % vs. 7.2 %, p<0.001). On admission, emergency medical service patients had more often confusion (43 (14.2 %) vs. 4 (2.1 %), p<0.001) and higher respiratory rate (24/min vs. 21/min, p=0.014; respiratory rate > 30/min in 17.1 % patients vs. 7.5 %, p=0.005). The only difference in emergency department management appeared in the use of ventilatory support: 78.3 % of emergency medical services patients vs. 67.5% of non- emergency medical services patients received oxygen, p=0.007, non-invasive ventilation was administered to 12.5 % of emergency medical service patients vs. 4.2% non- emergency medical service patients, p=0.002. Emergency medical service patients were more often hospitalized (82.4 % vs. 65.9 %, p<0.001). The use of emergency medical services was an independent predictor of 30-day mortality (OR=2.96, 95% CI 1.27-6.92, p=0.012)Conclusion: Most acute heart failure patients arrive at emergency department by emergency medical services. These patients suffer from more severe respiratory distress and receive more often ventilatory support. Emergency medical service use is an independent predictor of 30-day mortality.

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Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620930889 ◽

2020 ◽

Vol 9 (5) ◽

pp. 375-398

Author(s):

Òscar Miró ◽

Xavier Rossello ◽

Elke Platz ◽

Josep Masip ◽

Danielle M Gualandro ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Emergency Department ◽

Risk Stratification ◽

Acute Heart Failure ◽

Mortality Risk ◽

Heart Failure Patients ◽

Hospitalised Patients ◽

Risk Grade ◽

Estimation Of Risk

Aims This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients. Methods and results A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4–13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74–0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80–0.84. Conclusions There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.

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