Spanish risk score predicts 30-day mortality in acute HF in ED patients


Background: The MEESSI-AHF (Multiple Estimation of Risk based on the Emergency Department Spanish Score In patients with Acute Heart Failure) score is a risk-stratification tool that includes systolic blood pressure, age, NT-proBNP, potassium, cardiac troponin T, New York Heart Association class 4 disease, respiratory rate, low-output symptoms, oxygen saturation, episode associated with acute coronary syndrome, signs of left ventricular hypertrophy on EKG, creatinine, and Barthel Index Score. Prior research has shown that it accurately risk-stratified ED patients with AHF in Spain. It has not been studied in other populations.

Dr. Shree Radhakrishnan, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston

Dr. Shree Radhakrishnan

Study design: Prospective multicenter cohort study.

Setting: Adult ED patients with acute dyspnea in four hospitals in Switzerland.

Synopsis: The study included 1,247 nonhemodialysis patients who presented to the ED with acute dyspnea, were found to have all the necessary variables to calculate the MEESSI-AHF score, and were adjudicated to have acute heart failure. The authors calculated a modified MEESSI-AHF score, excluding the Barthel Index for all patients. The authors found that a six-group modified MEESSI-AHF risk-stratification model could predict 30-day mortality with excellent discrimination (C-Statistic, 0.80). Limitations of the study include the exclusion of all hemodynamically unstable patients and those on hemodialysis.

Bottom line: The MEESSI-AHF score effectively predicts 30-day mortality in AHF in Swiss and Spanish ED patients.

Citation: Wussler D et al. External validation of the MEESSI acute heart failure risk score: A cohort study. Ann Intern Med. 2019;170:248-56.

Dr. Radhakrishnan is a hospitalist at Beth Israel Deaconess Medical Center.

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