Key result
EHMRG and MEESSI-AHF risk scores accurately predict short-term acute heart failure mortality with c-statistics up to ~0.84.
Why the study?
This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients.
Do risk stratification scores accurately predict mortality in acute heart failure patients in the emergency department?
Systematic Review
Do risk stratification scores accurately predict mortality in acute heart failure patients in the emergency department?
The EHMRG and MEESSI-AHF risk scores are accurate and validated tools for predicting short-term mortality in emergency department patients with acute heart failure, aiding in admission versus discharge decisions.
Answers are grounded in this paper and cite their sources.
Accurate prediction supports ED disposition decisions in acute HF; extends multicentre validation but leaves open implementation effects on outcomes.
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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Miró et al. (2020) conducted a systematic review in Acute heart failure. Risk stratification scores (e.g., EHMRG, MEESSI-AHF) vs. Clinical judgment or other risk scores was evaluated on Model performance (c-statistic) for predicting short-term mortality (e.g., 7-day or 30-day). The EHMRG and MEESSI-AHF risk scores demonstrated high accuracy for predicting short-term mortality in emergency department acute heart failure patients, with c-statistics ranging from 0.74 to 0.84.
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