Usefulness of MEESSI-AHF and EHMRG scores in predicting short-term mortality in patients with acute heart failure in an Indian population

Background Acute heart failure (AHF) is a complex, potentially fatal condition characterized by rapid symptom onset due to inefficient heart function. Globally, AHF poses a significant burden, with incidence and outcomes varying by geography, demographics, and clinical factors. In India, cardiovascular diseases contribute heavily to morbidity and mortality, making accurate prediction of short-term mortality in AHF patients critical for improving patient management. There is a critical lack of prospective data validating international risk scores within the Indian healthcare ecosystem. This study aimed to compare the MEESSI-AHF and EHMRG scores in predicting short-term mortality in AHF patients in India, and to determine which model provides better risk stratification, potentially guiding clinical decisions and enhancing patient management strategies. Methods A prospective single-center validation study was conducted from January to July 2024 in a tertiary care center in Coastal Karnataka. AHF patients diagnosed using the Framingham criteria and the ESC diagnostic algorithm were assessed at admission, with MEESSI-AHF and EHMRG scores calculated. Mortality outcomes were tracked at day 7 and day 30 by phone call or follow-up visit. Data were analyzed using SPSS 29.0. The area under the receiver operating characteristic curve (AUC) was used to assess the discrimination of both scores for 7-day and 30-day mortality, and the AUCs were compared using the DeLong test, with a two-sided p-value < 0.05 considered significant. Results Of 128 patients enrolled, 127 had a determinate outcome and were analyzed. For 30-day mortality the AUC was 0.862 for MEESSI-AHF and 0.874 for EHMRG; for 7-day mortality it was 0.819 and 0.827, respectively, with no significant difference between the two scores at either time point (DeLong p = 0.665 and p = 0.803). NYHA class IV, ACS episodes, NT-proBNP, and serum creatinine were associated with 30-day mortality in univariable analysis; in an exploratory multivariable model, only NT-proBNP remained independently associated with mortality after adjustment for creatinine. Conclusions In this single-center prospective cohort of Indian patients with acute heart failure, MEESSI-AHF and EHMRG showed good and similar discriminatory performance for short-term mortality. Calibration assessment showed that EHMRG substantially underestimated absolute 7-day mortality (mean predicted 3.0% vs. observed 8.7%), while MEESSI-AHF showed only modest underestimation for 30-day mortality. Given the small number of events, these findings should be considered preliminary and require confirmation, together with local recalibration, in larger multicenter cohorts.