Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

Falsetti, Lorenzo; Zaccone, Vincenzo; Viticchi, Giovanna; Fioranelli, Agnese; Diblasi, Ilaria; Guerrieri, Emanuele; Ferrini, Consuelo; Scarponi, Mattia; Giuliani, Luca; Scalpelli, Caterina; Martino, Marianna; Pansoni, Adolfo; Luccarini, Marinella; Burattini, Maurizio; Moroncini, Gianluca; Tarquinio, Nicola

doi:10.3390/diagnostics12020478

Cited by 2 publications

(3 citation statements)

References 57 publications

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“…Particularly, EHMRG can be calculated only by vital parameters and data retrieved from the first contact between the patient and the triage nurse, and laboratory exams that are measured virtually in all the ED patients. However, despite its usability, its accuracy should be assessed, especially when translated to populations or emergency systems that differ from the original cohort, like all the clinical scores [ 24 , 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure

Falsetti

Zaccone

Guerrieri

et al. 2022

JCM

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Acute heart failure (AHF) is a cardiac emergency with an increasing incidence, especially among elderly patients. The Emergency Heart failure Mortality Risk Grade (EHMRG) has been validated to assess the 7-days AHF mortality risk, suggesting the management of patients admitted to an emergency department (ED). EHMRG has never been implemented in Italian ED nor among elderly patients. We aimed to assess EHMRG score accuracy in predicting in-hospital death in a retrospective cohort of elderly subjects admitted for AHF from the ED to an Internal Medicine Department. We enrolled, in a 24-months timeframe, all the patients admitted to an Internal Medicine Department from ED for AHF. We calculated the EHMRG score, subdividing patients into six categories, and assessing in-hospital mortality and length of stay. We evaluated EHMRG accuracy with ROC curve analysis and survival with Kaplan–Meier and Cox models. We collected 439 subjects, with 45 in-hospital deaths (10.3%), observing a significant increase of in-hospital death along with EHMRG class, from 0% (class 1) to 7.7% (class 5b; p < 0.0001). EHMRG was fairly accurate in the whole cohort (AUC: 0.75; 95%CI: 0.68–0.83; p < 0.0001), with the best cutoff observed at >103 (Se: 71.1%; Sp: 72.8%; LR+: 2.62; LR-: 0.40; PPV: 23.0%; NPV: 95.7%), but performed better considering the events in the first seven days of admission (AUC: 0.83; 95%; CI: 0.75–0.91; p < 0.0001). In light of our observations, EHMRG can be useful also for the Italian emergency system to predict the risk of short-term mortality for AHF among elderly patients. EHMRG performance was better in the first seven days but remained acceptable when considering the whole period of hospitalization.

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Section: Discussionmentioning

confidence: 99%

“…Background: Methods of this study have already been described elsewhere [ 24 ]. The INRCA-IRCSS (National Institute for Care and Research in Aging, Ancona, Italy) Hospital of Osimo (Ancona, Italy) is a primary hospital specializing in the acute care of elderly subjects.…”

Section: Methodsmentioning

confidence: 99%

Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure

Falsetti

Zaccone

Guerrieri

et al. 2022

JCM

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“…Several predictive models, such as the EHMRG score, have been suggested to assess short-term AHF prognosis since the patient’s arrival in the ED. These models are largely validated and should be preferred to stratify the 7-day mortality risk over other approaches, even in a geriatric patient [ 43 , 44 ]. However, our study suggests that applying the clinical method and correctly assessing the patient’s burden of comorbidities could be useful for the practicing clinician to evaluate the patient’s complexity and assess their short-term mortality risk according to their history.…”

Section: Discussionmentioning

confidence: 99%

Clusters of Comorbidities in the Short-Term Prognosis of Acute Heart Failure among Elderly Patients: A Retrospective Cohort Study

et al. 2022

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Background and Objectives: Elderly patients affected by acute heart failure (AHF) often show different patterns of comorbidities. In this paper, we aimed to evaluate how chronic comorbidities cluster and which pattern of comorbidities is more strongly related to in-hospital death in AHF. Materials and Methods: All patients admitted for AHF to an Internal Medicine Department (01/2015–01/2019) were retrospectively evaluated; the main outcome of this study was in-hospital death during an admission for AHF; age, sex, the Charlson comorbidity index (CCI), and 17 different chronic pathologies were investigated; the association between the comorbidities was studied with Pearson’s bivariate test, considering a level of p ≤ 0.10 significant, and considering p < 0.05 strongly significant. Thus, we identified the clusters of comorbidities associated with the main outcome and tested the CCI and each cluster against in-hospital death with logistic regression analysis, assessing the accuracy of the prediction with ROC curve analysis. Results: A total of 459 consecutive patients (age: 83.9 ± 8.02 years; males: 56.6%). A total of 55 (12%) subjects reached the main outcome; the CCI and 16 clusters of comorbidities emerged as being associated with in-hospital death from AHF. Of these, CCI and six clusters showed an accurate prediction of in-hospital death. Conclusions: Both the CCI and specific clusters of comorbidities are associated with in-hospital death from AHF among elderly patients. Specific phenotypes show a greater association with a worse short-term prognosis than a more generic scale, such as the CCI.

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Improving the EHMRG Prognostic Evaluation of Acute Heart Failure with TAPSE/PASp: A Sequential Approach

Cited by 2 publications

References 57 publications

Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure

Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure

Clusters of Comorbidities in the Short-Term Prognosis of Acute Heart Failure among Elderly Patients: A Retrospective Cohort Study

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