External Validation of the MEESSI Acute Heart Failure Risk Score

Wussler, Desiree; Kozhuharov, Nikola; Sabti, Zaid; Walter, Joan; Strebel, Ivo; Scholl, Letizia; Miró, Òscar; Rosselló, Xavier; Martín‐Sánchez, Francisco Javier; Pocock, Stuart J.; Nowak, Albina; Badertscher, Patrick; Twerenbold, Raphael; Wildi, Karin; Puelacher, Christian; Lavallaz, Jeanne du Fay de; Shrestha, Samyut; Strauch, Olivia; Flores, Dayana; Nestelberger, Thomas; Boeddinghaus, Jasper; Schumacher, Carmela; Goudev, Assen; Pfister, Otmar; Breidthardt, Tobias; Mueller, Christian

doi:10.7326/m18-1967

Cited by 43 publications

(27 citation statements)

References 29 publications

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“…Thirty‐five independent variables were recorded, including demographic data (2), co‐morbidities (13), baseline status (3), triggers of the AHF episode (6), vitals (3) and blood analytical results (6) at ED arrival and severity of the AHF index episode (2) (see online supplementary Table for definitions). The two variables assessing the severity of the FEAHF consisted in: (i) calculation of the MEESSI risk score for every patient, as this risk score has recently been reported to accurately estimate the risk of death during the following 30 days in patients diagnosed with AHF in the ED, and (ii) determination of the need for hospitalisation during the index episode. In addition, AHF‐related treatments provided after FEAHF discharge were recorded: renin–angiotensin system inhibitors (RASI), beta‐blockers, mineralo‐corticosteroid receptor blockers (MCRB), loop and thiazide diuretics and digoxin.…”

Section: Methodsmentioning

confidence: 99%

Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort

Sarasola

Fuenzalida

Calderón

et al. 2019

European J of Heart Fail

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ObjectivesWe investigated the natural history of patients after a first episode of acute heart failure (FEAHF) requiring emergency department (ED) consultation, focusing on: the frequency of ED visits and hospitalisations, departments admitting patients during the first and subsequent hospitalisations, and factors associated with difficult disease control.We included consecutive patients diagnosed with FEAHF (either with or without previous heart failure diagnosis) in four EDs during 5 months in three different time periods (2009, 2011, 2014). Diagnosis was adjudicated by local principal investigators. The clinical characteristics of the index event were prospectively recorded, and all post-discharge ED visits and hospitalisations [related/unrelated to acute heart failure (AHF)], as well as departments involved in subsequent hospitalisations were retrospectively ascertained. 'Uncontrolled disease' during the first year after FEAHF was considered if patients were attended at ED (≥ 3 times) or hospitalised (≥ 2 times) for AHF or died. Overall, 505 patients with FEAHF were included and followed for a mean of 2.4 years. In-hospital mortality was 7.5%. Among 467 patients discharged alive, 288 died [median survival 3.9 years, 95% confidence interval (CI) 3.5-4.4], 421 (90%) revisited the ED (2342 ED visits; 42.4% requiring hospitalisation, 34.0% AHF-related) and 357 Ò. Miró et al.(77%) were hospitalised (1054 hospitalisations; 94.1% through ED, 51.4% AHF-related). AHF-related hospitalisations were mainly in internal medicine (28.0%), short-stay unit (26.3%), cardiology (20.8%), and geriatrics (14.1%). Only 47.4% of AHF-related hospitalisations were in the same department as the FEAHF, and internal medicine involvement significantly increased with subsequent hospitalisations (P = 0.01). Uncontrolled disease was observed in 31% of patients, which was independently related to age > 80 years [odds ratio (OR) 1.80, 95% CI 1.17-2.77], systolic blood pressure < 110 mmHg at ED arrival (OR 2.61, 95% CI 1. 26-5.38) and anaemia (OR 2.39, 95% CI

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Section: Methodsmentioning

confidence: 99%

Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort

Sarasola

Fuenzalida

Calderón

et al. 2019

European J of Heart Fail

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“…Among the 761 screened citations, 28 studies published over the last 10 years 8,20,24,35–59 met the inclusion criteria after full-text review (Figure 1). These 28 studies included 19 different risk models that had been used in AHF patients in the ED setting to predict clinical outcomes (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…In this sense, CTAS+age+sex had a significantly higher discriminative capacity than CTAS for all the assessed outcomes; 52 MTS and MAT-SET had comparable performance in outcomes prediction; 53 BI-EFFECT was better than EFFECT-HF, and FBI-EFFECT better than both, in predicting 30-day mortality; 35,55 EHMRG was better than EFFECT-HF in predicting seven-day mortality; 54 AHFRS provided clearly better estimations than BWH, ADHERE, GWTG-HS and EAHFE-3D, and was similar to EHMRG in predicting short-term SAE (although no p value for any of these comparisons was provided); 39 EHMRG30-ST had comparable performance in predicting 30-day mortality to EHMRG in predicting seven-day mortality in two studies; 44,56 and MEESSI-AHF was better than EHMRG in predicting 30-day mortality in two studies. 38,41 However, it has to be taken into account that many of these comparisons can be considered ‘unfair’, as they were performed in cohorts used for derivation of one of the compared scales, used outcomes different from those evaluated in original derivation in some of the compared scales, or were run in countries where one of the scales under comparison was derived. Therefore, objective comparisons using independent and new multinational populations are still lacking.…”

Section: Resultsmentioning

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

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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.

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“…Following the same criteria of the EAHFE cohort, patients with AHF concomitant with ACS was excluded. Complete details of the BASEL V cohort have been described elsewhere 18 . Differences were considered to be statistically significant with a P value < .05, or when the HR excluded the value 1.…”

Section: Methodsmentioning

confidence: 99%

High‐sensitivity cardiac troponin T 30 days all‐come mortality in patients with acute heart failure. A Propensity Score‐Matching Analysis Based on the EAHFE Registry. TROPICA4 Study

Roset

Jacob

Herrero‐Puente

et al. 2020

Eur J Clin Investigation

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Background: Acute heart failure (AHF) patients with high troponin levels have a worse prognosis. High-sensitive troponin T (hs-TnT) has been used as a tool to stratify prognosis in many scales but always as a qualitative and not as a quantitative variable. Objectives: The main objective of this study was to determine the best hs-TnT cutoff for prediction of 30-day all-cause mortality. Methods: The EAHFE registry, a prospective follow-up cohort of patients with AHF, was analysed. We performed a propensity score analysis of the optimal hs-TnT cut-off point previously determined by receiver operating characteristic (ROC) curve analysis. Results: Of the 13 791 patients in the EAHFE cohort, we analysed 3190 patients in whom hs-TnT determination was available. The area under the ROC curve for 2 of 11 | ROSET ET al.

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External Validation of the MEESSI Acute Heart Failure Risk Score

Cited by 43 publications

References 29 publications

Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort

Departments involved during the first episode of acute heart failure and subsequent emergency department revisits and rehospitalisations: an outlook through the NOVICA cohort

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

High‐sensitivity cardiac troponin T 30 days all‐come mortality in patients with acute heart failure. A Propensity Score‐Matching Analysis Based on the EAHFE Registry. TROPICA4 Study

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