Abstract Background Acute heart failure (AHF) is defined as new-onset or worsening of symptoms and signs of heart failure including symptoms or signs related to congestion and volume overload. Patients presenting with AHF are a heterogeneous group as AHF is not a specific disease but a shared clinical presentation of different cardiac abnormalities. Due to the heterogeneity of the patient population, a prognostic tool is needed to identify AHF patients with a high risk of all-cause mortality. An early warnings system (EWS) is part of a "track-and-trigger" system that aims to improve the early identification and management of deteriorating patients in hospital wards. The National Early Warning Score (NEWS) is a system for scoring the physiological measurements recorded at the patient's bedside and is developed to predict acute mortality within 24 hours. The NEWS has previously been used to evaluate the out-of-hospital mortality for patients admitted to the Emergency Department (ED). The Clinical Early Warning Score (CEWS) is an updated version of NEWS that incorporates a clinical assessment. There is limited data regarding the role of the NEWS and CEWS in predicting adverse outcomes in patients with AHF. Purpose The purpose of this study is to investigate if NEWS and CEWS can be used to predict 1-year out-of-hospital mortality in patients hospitalized with AHF and to examine if one scoring system is superior. Methods This prospective, observational cohort study included consecutive patients with AHF admitted through the emergency department (ED) at a large public hospital from 10 March 2020 to 31 March 2022 and had a follow-up period of 1 year. Investigators assessed patients for the presence of AHF. Patient groups were stratified into high-risk and low-risk groups. According to the cut-off value for the scoring systems patients in high-risk groups were defined as NEWS ≥ 7 or CEWS ≥ 7. The primary outcome was all-cause mortality at 1 year. We used multivariable Cox regression (hazard ratios HRs) to compare survival, adjusting for age, sex, smoking, and known heart failure (HF). Results In the study period 10 March 2020 to 31 March 2022, 408 patients were identified with AHF. 2 patients had no NEWS registered. A Kaplan-Meier plot revealed a statistically significant difference in 1-year all-cause mortality between low-risk and high-risk NEWS and CEWS groups among AHF patients (NEWS p-value 0.001 and CEWS p-value 0.001). After multivariable adjustment, high NEWS (HR, 1.93; CI, 1.36 to 2.73) (p-value= 0.001), high CEWS (HR, 1.13; CI, 1.07 to 1.19) and older age (HR, 1.05; CI 1.03 to 1.07) were statistically associated with mortality (p 0.001). Conclusion In this prospective, observational cohort study of AHF patients presenting at the ED with NEWS ≥ 7 or CEWS ≥ 7 were associated with a significant 1-year all-cause mortality.Graphical abstract Receiver Operating Characteristic Curve
Caidi et al. (Sat,) studied this question.