Validation of the Acute Heart Failure Index

Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims

“…The model had a negative likelihood ratio of 0.24 (0.18 to 0.32) for identification of 30-day mortality or serious complications. 109 Although markers of low-risk presentations have remained somewhat elusive, alternatives to hospitalization have also been investigated. Because the majority of hospitalizations originate from the ED, emergency physicians have considerable experience stabilizing patients, initiating treatment, and determining disposition in patients with AHFS.…”

“…They retrospectively analyzed an administrative database to derive and validate a predictive instrument that identified 19.2% of AHFS patients at low risk for 30-day adverse events. 109 Their validated model incorporated vital signs, renal function, white blood cell count, and glucose as risk predictors. Events were infrequent in the low-risk cohort with inpatient mortality, in-hospital complication, and 30-day mortality rates of 0.7%, 1.7%, and 2.9%, respectively.…”

Factors Associated With Neurologically Intact Survival for Patients With Acute Heart Failure and In-Hospital Cardiac Arrest

“…Factors such as malignancy, sepsis, and mechanical ventilation have been previously found to correlate with decreased rates of cardiopulmonary resuscitation survival for the general population, 13,29,30 and their association may be reflective of underlying critical illness rather than a direct association with acute HF. A correlation between hypotension/hypoperfusion and poor outcome in acute HF, however, has been consistently demonstrated, 5,6,9,31 and our finding to that effect is not surprising. That continuous infusion of vasopressors (and, to a lesser degree, dobutamine) was independently associated with non-NIS, however, suggests that risk may be especially high for patients who require pharmacotherapeutic measures to maintain adequate perfusion pressure.…”

“…7 Prognostication based on individual variables such as blood pressure and renal function and the use of predictive models can assist with risk stratification for HF mortality 2,6,8,9 but provide little information with regard to actual outcomes for those who experience a cardiac arrest. Although previous investigation has shown that most patients with HF would elect to have cardiopulmonary resuscitation performed if they suffered a life-threatening cardiac event, many fear consequential development of long-term neurological disability.…”

Confounded by Hospitalization: Risk Stratification and Admission Decisions in Emergency Department Patients With Acute Heart Failure

“…While some models appear promising, how they augment clinical decisionmaking is unclear. 6 With the complexity and comorbidity that accompanies each AHF patient, we are increasingly skeptical that such a readily implementable, dichotomous…”