Òscar Miró1, Xavier Rossello1, Víctor Gil1, Francisco Javier Martín-Sánchez1, Pere Llorens1, Pablo Herrero-Puente1, Javier Jacob1, Héctor Bueno1, Stuart J Pocock1. 1. From Hospital Clínic, University of Barcelona, Barcelona, Spain; London School of Hygiene and Tropical Medicine, London, United Kingdom; National Centre for Cardiovascular Research, Hospital Clínico San Carlos, Hospital Universitario 12 de Octubre, and Universidad Complutense, Madrid, Spain; Hospital General de Alicante, Alicante, Spain; Hospital Universitario Central de Asturias, Oviedo, Spain; and Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.
Abstract
Background: Physicians in the emergency department (ED) need additional tools to stratify patients with acute heart failure (AHF) according to risk. Objective: To predict mortality using data that are readily available at ED admission. Design: Prospective cohort study. Setting: 34 Spanish EDs. Participants: The derivation cohort included 4867 consecutive ED patients admitted during 2009 to 2011. The validation cohort comprised 3229 patients admitted in 2014. Measurements: 88 candidate risk factors and 30-day mortality. Results: Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score. This score predicted 30-day mortality with excellent discrimination (c-statistic, 0.836) and calibration (Hosmer-Lemeshow P = 0.99) and provided a steep gradient in 30-day mortality across risk groups (<2% for patients in the 2 lowest risk quintiles and 45% in the highest risk decile). These characteristics were confirmed in the validation cohort (c-statistic, 0.828). Multiple sensitivity analyses did not find important amounts of confounding or bias. Limitations: The study was confined to a single country. Participating EDs were not selected randomly. Many patients had missing data. Measurement of some risk factors was subjective. Conclusion: This tool has excellent discrimination and calibration and was validated in a different cohort from the one that was used to develop it. Physicians can consider using this tool to inform clinical decisions as further studies are done to determine whether the tool enhances physician decision making and improves patient outcomes. Primary Funding Source: Instituto de Salud Carlos III, Spanish Ministry of Health; Fundació La Marató de TV3; and Catalonia Govern.
Background: Physicians in the emergency department (ED) need additional tools to stratify patients with acute heart failure (AHF) according to risk. Objective: To predict mortality using data that are readily available at ED admission. Design: Prospective cohort study. Setting: 34 Spanish EDs. Participants: The derivation cohort included 4867 consecutive ED patients admitted during 2009 to 2011. The validation cohort comprised 3229 patients admitted in 2014. Measurements: 88 candidate risk factors and 30-day mortality. Results: Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score. This score predicted 30-day mortality with excellent discrimination (c-statistic, 0.836) and calibration (Hosmer-Lemeshow P = 0.99) and provided a steep gradient in 30-day mortality across risk groups (<2% for patients in the 2 lowest risk quintiles and 45% in the highest risk decile). These characteristics were confirmed in the validation cohort (c-statistic, 0.828). Multiple sensitivity analyses did not find important amounts of confounding or bias. Limitations: The study was confined to a single country. Participating EDs were not selected randomly. Many patients had missing data. Measurement of some risk factors was subjective. Conclusion: This tool has excellent discrimination and calibration and was validated in a different cohort from the one that was used to develop it. Physicians can consider using this tool to inform clinical decisions as further studies are done to determine whether the tool enhances physician decision making and improves patient outcomes. Primary Funding Source: Instituto de Salud Carlos III, Spanish Ministry of Health; Fundació La Marató de TV3; and Catalonia Govern.
Authors: Òscar Miró; V Íctor Gil; Francisco Javier Martín-Sánchez; Javier Jacob; Pablo Herrero; Aitor Alquézar; Lluís Llauger; Sira Aguiló; Gemma Martínez; José Ríos; Alberto Domínguez-Rodríguez; Veli-Pekka Harjola; Christian Müller; John Parissis; W Frank Peacock; Pere Llorens Journal: Clin Res Cardiol Date: 2018-03-28 Impact factor: 5.460
Authors: Òscar Miró; Koji Takagi; Étienne Gayat; Víctor Gil; Pere Llorens; Francisco J Martín-Sánchez; Javier Jacob; Pablo Herrero-Puente; Rosa Escoda; María Pilar López-Díez; Amparo Valero; Marta Fuentes; José M Garrido; Eva Salvo; Miguel A Rizzi; Alfons Aguirre; Lissete Travería Bécquer; Alberto Domínguez-Rodríguez; Joan Padrosa; Gemma Martínez; Mattia Arrigo; Yonathan Freund; Alexandre Mebazaa Journal: Clin Res Cardiol Date: 2019-04-29 Impact factor: 5.460
Authors: Pere Llorens; Patricia Javaloyes; Francisco Javier Martín-Sánchez; Javier Jacob; Pablo Herrero-Puente; Víctor Gil; José Manuel Garrido; Eva Salvo; Marta Fuentes; Héctor Alonso; Fernando Richard; Francisco Javier Lucas; Héctor Bueno; John Parissis; Christian E Müller; Òscar Miró Journal: Clin Res Cardiol Date: 2018-05-04 Impact factor: 5.460
Authors: Òscar Miró; Xavier Rossello; Elke Platz; Josep Masip; Danielle M Gualandro; W Frank Peacock; Susanna Price; Louise Cullen; Salvatore DiSomma; Mucio Tavares de Oliveira; John Jv McMurray; Francisco J Martín-Sánchez; Alan S Maisel; Christiaan Vrints; Martin R Cowie; Héctor Bueno; Alexandre Mebazaa; Christian Mueller Journal: Eur Heart J Acute Cardiovasc Care Date: 2020-08
Authors: Peter S Pang; Gregory J Fermann; Benton R Hunter; Phillip D Levy; Kathleen A Lane; Xiaochun Li; Mette Cole; Sean P Collins Journal: Circ Heart Fail Date: 2019-07-10 Impact factor: 8.790