Clinical question: Can we use readily available data to risk stratify patients who present to the emergency department in acute heart failure (AHF)?
Background: Although cardiac biomarkers such as troponin and B-natriuretic peptide have general prognostic value in patients with AHF presenting to the emergency department, these values do not reliably aid in determining patients’ risk for unfavorable outcomes at the time of clinical decision making. Currently available published scores for risk-stratifying patients with AHF in the ED have limited applicability.
Study design: Prospective cohort study (with second validation cohort).
Setting: The registry included patients from 34 different hospitals in Spain.
Synopsis: This study analyzed clinical variables from a cohort of 4,897 AHF patients to determine predictors of patient outcomes. Thirteen clinical variables were identified as independent predictors of 30-day mortality and were incorporated into a risk score calculator (MEESSI-AHF). The risk score includes variables such as vital signs, age, labs values, and performance status. A second cohort of 3,229 patients were used to validate the risk score. The risk score effectively discriminates patients into low-, intermediate-, and high-risk patients. One important limitation is a high number of missing values in derivation cohort that required advanced statistics to overcome. The generalizability of the population studies (Spanish population) to other countries is still unclear. A risk score that can reasonably identify low-risk patients may be the most clinically useful in order to identify patients that either can be treated effectively in the emergency department and may not warrant inpatient admission.
Bottom line: The MEESSI-AHF risk score may be a helpful tool in identifying the risk of 30-day mortality in patients who present to the ED with AHF, but it is currently unclear if the score can be generalized to other populations.
Citation: Miro O et al. Predicting 30-day mortality for patients with acute heart failure in the emergency department: A cohort study. Ann Intern Med. 2017 Nov 21;167(10):698-705.
Dr. Maleque is assistant professor of medicine in the division of hospital medicine, Emory University, Atlanta.