Adrien Basset1, Emmanuel Nowak2, Philippe Castellant3, Christophe Gut-Gobert4, Grégoire Le Gal5, Erwan L'Her6. 1. Urgences adultes, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. 2. Centre d'investigation clinique, INSERM CIC 1412, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. 3. Pneumologie, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. 4. Cardiologie, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France. 5. Centre d'investigation clinique, INSERM CIC 1412, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. 6. Urgences adultes, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; Réanimation Médicale, CHRU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; LATIM, INSERM UMR 1101, Université de Bretagne Occidentale, 29200 Brest, France. Electronic address: erwan.lher@chu-brest.fr.
Abstract
OBJECTIVE: To derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting. DESIGN: Derivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort. INTERVENTIONS AND MEASURES: During the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee. RESULTS: The score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (-2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9). CONCLUSION: This score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergency patients may enable a more rapid and efficient diagnostic process.
OBJECTIVE: To derive and validate a clinical prediction rule of acute congestive heart failure obtainable in the emergency care setting. DESIGN: Derivation of the score was performed on a retrospective 927 patients cohort admitted to our Emergency Department for dyspnea. The prediction model was externally validated on an independent 206-patient prospective cohort. INTERVENTIONS AND MEASURES: During the derivation phase, variables associated with acute congestive heart failure were included in a multivariate regression model. Logistic regression coefficients were used to assign scoring points to each variable. During the validation phase, every diagnosis was confirmed by an independent adjudication committee. RESULTS: The score comprised 11 variables: age ≥65 years (1 point), seizure dyspnea (2 points), night outbreak (1 point), orthopnea (1 point), history of pulmonary edema (2 points), chronic pulmonary disease (-2 points), myocardial infarction (1 point), crackles (2 points), leg edema (1 point), ST-segment abnormality (1 point), atrial fibrillation/flutter (1 point) on electrocardiography. In the validation step, 30 patients (14.6%) had a low clinical probability of acute congestive heart failure (score ≤3), of which only 2 (6.7%) had a proven acute cardiogenic pulmonary edema. The prevalence of acute congestive heart failure was 58.5% in the 94 patients with an intermediate probability (score of 4-8) and 91.5% in the 82 patients (39.8%) with a high probability (score ≥9). CONCLUSION: This score of acute congestive heart failure based on easily available and objective variables is entirely standardized. Applying the score to dyspneic adult emergencypatients may enable a more rapid and efficient diagnostic process.