Xavier Rossello1,2, Héctor Bueno2,3,4, Víctor Gil5, Javier Jacob6, Francisco Javier Martín-Sánchez2,7,8, Pere Llorens9, Pablo Herrero Puente10, Aitor Alquézar-Arbé11, Sergio Raposeiras-Roubín2,12, M Pilar López-Díez13, Stuart Pocock2,14, Òscar Miró5. 1. Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Spain. 2. Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain. 3. Instituto de Investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain. 4. Facultad de Medicina, Universidad Complutense de Madrid, Spain. 5. Emergency Department, Hospital Clínic i Provincial de Barcelona, University of Barcelona, Spain. 6. Emergency Department, Hospital Universitari de Bellvitge, Spain. 7. Emergency Department, Hospital Clínico San Carlos, Spain. 8. Instituto de Investigación Sanitaria San Carlos (IdISSC), Universidad Complutense de Madrid, Spain. 9. Emergency Department, Hospital General de Alicante, Spain. 10. Emergency Department, Hospital Universitario Central de Asturias, Spain. 11. Emergency Department, Hospital de la Santa Creu i Sant Pau, Spain. 12. Department of Cardiology, University Hospital Álvaro Cunqueiro, Spain. 13. Emergency Department, Hospital Universitario de Burgos, Spain. 14. Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK.
Abstract
BACKGROUND: The multiple estimation of risk based on the emergency department Spanish score in patients with acute heart failure (MEESSI-AHF) is a risk score designed to predict 30-day mortality in acute heart failure patients admitted to the emergency department. Using a derivation cohort, we evaluated the performance of the MEESSI-AHF risk score to predict 11 different short-term outcomes. METHODS: Patients with acute heart failure from 41 Spanish emergency departments (n=7755) were recruited consecutively in two time periods (2014 and 2016). Logistic regression models based on the MEESSI-AHF risk score were used to obtain c-statistics for 11 outcomes: three with follow-up from emergency department admission (inhospital, 7-day and 30-day mortality) and eight with follow-up from discharge (7-day mortality, emergency department revisit and their combination; and 30-day mortality, hospital admission, emergency department revisit and their two combinations with mortality). RESULTS: The MEESSI-AHF risk score strongly predicted mortality outcomes with follow-up starting at emergency department admission (c-statistic 0.83 for 30-day mortality; 0.82 for inhospital death, P=0.121; and 0.85 for 7-day mortality, P=0.001). Overall, mortality outcomes with follow-up starting at hospital discharge predicted slightly less well (c-statistic 0.80 for 7-day mortality, P=0.011; and 0.75 for 30-day mortality, P<0.001). In contrast, the MEESSI-AHF score predicted poorly outcomes involving emergency department revisit or hospital admission alone or combined with mortality (c-statistics 0.54 to 0.62). CONCLUSIONS: The MEESSI-AHF risk score strongly predicts mortality outcomes in acute heart failure patients admitted to the emergency department, but the model performs poorly for outcomes involving hospital admission or emergency department revisit. There is a need to optimise this risk score to predict non-fatal events more effectively. Published on behalf of the European Society of Cardiology. All rights reserved.
BACKGROUND: The multiple estimation of risk based on the emergency department Spanish score in patients with acute heart failure (MEESSI-AHF) is a risk score designed to predict 30-day mortality in acute heart failurepatients admitted to the emergency department. Using a derivation cohort, we evaluated the performance of the MEESSI-AHF risk score to predict 11 different short-term outcomes. METHODS:Patients with acute heart failure from 41 Spanish emergency departments (n=7755) were recruited consecutively in two time periods (2014 and 2016). Logistic regression models based on the MEESSI-AHF risk score were used to obtain c-statistics for 11 outcomes: three with follow-up from emergency department admission (inhospital, 7-day and 30-day mortality) and eight with follow-up from discharge (7-day mortality, emergency department revisit and their combination; and 30-day mortality, hospital admission, emergency department revisit and their two combinations with mortality). RESULTS: The MEESSI-AHF risk score strongly predicted mortality outcomes with follow-up starting at emergency department admission (c-statistic 0.83 for 30-day mortality; 0.82 for inhospital death, P=0.121; and 0.85 for 7-day mortality, P=0.001). Overall, mortality outcomes with follow-up starting at hospital discharge predicted slightly less well (c-statistic 0.80 for 7-day mortality, P=0.011; and 0.75 for 30-day mortality, P<0.001). In contrast, the MEESSI-AHF score predicted poorly outcomes involving emergency department revisit or hospital admission alone or combined with mortality (c-statistics 0.54 to 0.62). CONCLUSIONS: The MEESSI-AHF risk score strongly predicts mortality outcomes in acute heart failurepatients admitted to the emergency department, but the model performs poorly for outcomes involving hospital admission or emergency department revisit. There is a need to optimise this risk score to predict non-fatal events more effectively. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: William B Stubblefield; Cathy A Jenkins; Dandan Liu; Alan B Storrow; John A Spertus; Peter S Pang; Phillip D Levy; Javed Butler; Anna Marie Chang; Douglas Char; Deborah B Diercks; Gregory J Fermann; Jin H Han; Brian C Hiestand; Christopher J Hogan; Yosef Khan; Sangil Lee; JoAnn M Lindenfeld; Candace D McNaughton; Karen Miller; W Frank Peacock; Jon W Schrock; Wesley H Self; Adam J Singer; Sarah A Sterling; Sean P Collins Journal: Circ Cardiovasc Qual Outcomes Date: 2021-09-24