Prediction of Early Adverse Events in Emergency Department Patients With Acute Heart Failure: A Systematic Review

Aims This study aimed to systematically identify and summarise all risk scores evaluated in the emergency department setting to stratify acute heart failure patients. Methods and results A systematic review of PubMed and Web of Science was conducted including all multicentre studies reporting the use of risk predictive models in emergency department acute heart failure patients. Exclusion criteria were: (a) non-original articles; (b) prognostic models without predictive purposes; and (c) risk models without consecutive patient inclusion or exclusively tested in patients admitted to a hospital ward. We identified 28 studies reporting findings on 19 scores: 13 were originally derived in the emergency department (eight exclusively using acute heart failure patients), and six in emergency department and hospitalised patients. The outcome most frequently predicted was 30-day mortality. The performance of the scores tended to be higher for outcomes occurring closer to the index acute heart failure event. The eight scores developed using acute heart failure patients only in the emergency department contained between 4–13 predictors (age, oxygen saturation and creatinine/urea included in six scores). Five scores (Emergency Heart Failure Mortality Risk Grade, Emergency Heart Failure Mortality Risk Grade 30 Day mortality ST depression, Epidemiology of Acute Heart Failure in Emergency department 3 Day, Acute Heart Failure Risk Score, and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) have been externally validated in the same country, and two (Emergency Heart Failure Mortality Risk Grade and Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure) further internationally validated. The c-statistic for Emergency Heart Failure Mortality Risk Grade to predict seven-day mortality was between 0.74–0.81 and for Multiple Estimation of risk based on Emergency department Spanish Score In patients with Acute Heart Failure to predict 30-day mortality was 0.80–0.84. Conclusions There are several scales for risk stratification of emergency department acute heart failure patients. Two of them are accurate, have been adequately validated and may be useful in clinical decision-making in the emergency department i.e. about whether to admit or discharge.

show abstract

“…All of these features have been proposed to be met by a scale that is intended to become clinical useful. 72…”

Section: Discussionmentioning

confidence: 99%

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Miró

Rosselló

Platz

et al. 2020

European Heart Journal. Acute Cardiovascular Care

View full text Add to dashboard Cite

show abstract

“…In accordance with published studies, 7 , 8 , 11 , 12 we created three groups of risk. A <5% probability of hospitalization/death 30 days after the decompensation episode indicated patients at low risk, 5–20% medium risk, and >20% high risk.…”

Section: Resultsmentioning

confidence: 99%

“…C‐statistics of 0.81, 95% CI: [0.77; 0.84] in the derivation and 0.74, 95% CI: [0.66; 0.81] in the validation cohorts, respectively, were reported. To date, these are the highest ranges of predictive scores published in studies on heart failure decompensation 7,8 …”

Section: Discussionmentioning

confidence: 99%

“…To date, these are the highest ranges of predictive scores published in studies on heart failure decompensation. 7 , 8 …”

Section: Discussionmentioning

confidence: 99%

“…These heterogeneous models, however, present high variability and have not been widely implemented in routine clinical practice. Almost all of them included hospitalized patients, and the few that assessed patients attended in primary care or outpatient clinics were based on variables not accessible to the majority of primary healthcare professionals 7,8 . In addition, they showed a reduced predictive capacity in patients with low risk of death 9…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Risk stratification in heart failure decompensation in the community: HEFESTOS score

et al. 2021

View full text Add to dashboard Cite

Aims Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings. Methods and results HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the derivation cohort and 58.8% in the validation one (P = 0.004). Mortality/hospitalization during the first 30 days after a decompensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles (OR: 2.35; P = 0.01), New York Heart Association functional class III/IV (OR: 2.11; P = 0.001), oxygen saturation ≤ 90% (OR: 4.98; P < 0.001), heart rate > 100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45; P < 0.001). The model showed an area under the curve (AUC) of 0.807, 95% confidence interval (CI): [0.770; 0.845] in the derivation cohort and AUC 0.73, 95% CI: [0.660; 0.808] in the validation one. No significant differences between both cohorts were observed (P = 0.08). Regarding probability of hospitalization/death, three risk groups were defined: low <5%, medium 5–20%, and high >20%. Outcome incidence was 2.7% for the low‐risk group, 12.8% for medium risk, and 46.2% for high risk in the derivation cohort, and 9.1%, 12.9%, and 39.6% in the validation one. Conclusions The HEFESTOS score, based on variables easily accessible in a community setting and validated in an external European cohort, properly predicted the risk of death/hospitalization during the first 30 days after an HF decompensation episode.

show abstract

Circulating galectin-3 on admission and prognosis in acute heart failure patients: a meta-analysis

Chen

Jiang

et al. 2019

Heart Fail Rev

View full text Add to dashboard Cite

Prediction of Early Adverse Events in Emergency Department Patients With Acute Heart Failure: A Systematic Review

Cited by 17 publications

References 20 publications

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Risk stratification scores for patients with acute heart failure in the Emergency Department: A systematic review

Risk stratification in heart failure decompensation in the community: HEFESTOS score

Circulating galectin-3 on admission and prognosis in acute heart failure patients: a meta-analysis

Contact Info

Product

Resources

About