Validating the acute heart failure index for patients presenting to the emergency department with decompensated heart failure

Abstract

Background The Acute Heart Failure Index (AHFI) is a previously derived prediction rule to identify patients presenting to emergency departments (EDs) with decompensated heart failure (DHF) at low risk for early life-threatening events. Study Objectives We sought to prospectively validate the AHFI. Methods Using a prospective cohort study, we included adult patients presenting to an urban university hospital ED with DHF. We gathered data on 21 variables to calculate the AHFI. Primary endpoints included inpatient death and non-fatal serious outcomes (myocardial infarction, ventricular fibrillation, cardiogenic shock, cardiac arrest, intubation, or cardiac reperfusion). Secondary endpoints included death from any cause or readmission for heart failure within 30 days. We calculated primary and secondary endpoint rates with 95% confidence intervals (CI) for the low- and higher-risk subgroups. Results We enrolled 259 patients. 245/259 (95%) were admitted. 60/259 (23%) met low risk criteria, of whom 1/60 (1.7%, CI 0.04–8.9) was discharged after sustaining pulseless electrical activity arrest. The comparable primary outcome rate in the derivation study was 1.4% (CI 1.1–1.7). 17/199 (8.5%, CI 5.1–13.3) higher-risk patients experienced an endpoint, compared with 13.3% (CI 12.9–13.7) in the derivation cohort. 1 low-risk patient (1.7%, CI 0.04–8.9) died within 30 days, and 5 (8.3%, CI 2.8–18.4) were readmitted. Corresponding rates in the derivation study were 2% and 5% respectively. Conclusion Our results are consistent with those previously reported for the low-risk subgroup of the AHFI. Further research is needed to determine impact, safety and the full range of generalizability of the AHFI as an adjunct to decision making.

Combining training in knowledge translation with quality improvement reduced 30‐day heart failure readmissions in a community hospital: a case study

“…Interviews with staff suggested that education efforts were inadequate for these patients and were characteristically delayed until the end of their admissions. Previous studies on our population confirmed lack of adherence to medication regimens to be a strong predictor of admission for decompensation [14], and that almost all heart failure patients presenting to our emergency room were admitted to the hospital [15].…”

“…Clinical prediction rules for stratifying risk of readmission, mortality Several prediction instruments have been developed for patients with DHF [20,38]. One has been validated in the authors' centre [15].…”

Transitions of Care in Heart Failure

“…The acute HF index is calculated from 21 prognostic indicators (eg, demographics, past medical history, vital signs, laboratory data, and ECG and radiology findings). 85 An algorithm dichotomizes patients into subgroups of low or high risk for mortality, serious medical complications, and rehospitalization within 30 days. Second, the Evaluation Study of Congestive HF and Pulmonary Artery Catheterization Effectiveness risk model and discharge score 86 extend previous research of patient risk factors at discharge.…”

Clustered Emergency Room Visits Following an Acute Heart Failure Admission: A Population‐Based Study

“…Given the poor outcomes associated with repeat ER visits and readmissions for HF, better strategies of risk stratification in the ER have been developed. 4,23 One of these, the Emergency Heart Failure Mortality Risk Grade, combines multiple point-of-care clinical parameters to guide admission decisions in the ER. This risk score has now been turned into an online calculator to assist ER physicians in assessing risk for a single HF visit.…”