Òscar Miró1, Víctor Gil2, Xavier Rosselló3, Francisco Javier Martín-Sánchez4, Pere Llorens5, Javier Jacob6, Pablo Herrero7, Sergio Herrera Mateo8, Fernando Richard9, Rosa Escoda2, Marta Fuentes10, Enrique Martín Mojarro11, Lluís Llauger12, Héctor Bueno13, Stuart Pocock14. 1. Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España. Facultad de Medicina, Universidad de Barcelona, España. 2. Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Barcelona, España. 3. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, Reino Unido. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España. CIBER de Enfermedades Cardiovasculares, Madrid, España. 4. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense de Madrid, España. 5. Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universidad Miguel Hernández, Elx, Alicante, España. 6. Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. 7. Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España. 8. Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 9. Servicio de Urgencias, Hospital Universitario de Burgos, España. 10. Servicio de Urgencias, Hospital Universitario de Salamanca, España. 11. Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, España. 12. Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, España. 13. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España. Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España. 14. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, Reino Unido. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, España.
Abstract
OBJECTIVES: To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events. METHODS: Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression. RESULTS: A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84). CONCLUSION: Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events.
OBJECTIVES: To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events. METHODS:Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression. RESULTS: A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84). CONCLUSION:Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events.
Authors: Ana García Sarasola; Miguel Alberto Rizzi; Aitor Alquezar Arbé; Sergio Herrera Mateo; Víctor Gil; Pere Llorens; Javier Jacob; Francisco Javier Martín-Sánchez; Pablo Herrero Puente; Rosa Escoda; Begoña Espinosa; Àlex Roset; Raquel Torres-Gárate; José Torres-Murillo; Ana B Mecina; María Pilar López-Díez; José María Álvarez Pérez; Josep Tost; Eva Salvo; María Luisa López-Grima; Cristina Gil; María Mir; Frank Rutzinska; Ovidiu Chioncel; Òscar Miró Journal: Clin Res Cardiol Date: 2020-09-21 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: Òscar Miró; Pia Harjola; Xavier Rossello; Víctor Gil; Javier Jacob; Pere Llorens; Francisco Javier Martín-Sánchez; Pablo Herrero; Gemma Martínez-Nadal; Sira Aguiló; María Luisa López-Grima; Marta Fuentes; José María Álvarez Pérez; Esther Rodríguez-Adrada; María Mir; Josep Tost; Lluís Llauger; Frank Ruschitzka; Veli-Pekka Harjola; Wilfried Mullens; Josep Masip; Ovidiu Chioncel; W Frank Peacock; Christian Müller; Alexandre Mebazaa Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-06-30