Predicting 30-Day Mortality for Patients With Acute Heart Failure in the Emergency Department: A Cohort Study
Abstract
Background
Physicians in the emergency department (ED) need additional tools to stratify patients with acute heart failure (AHF) according to risk.
Objective
To predict mortality using data that are readily available at ED admission.
Design
Prospective cohort study.
Setting
34 Spanish EDs.
Participants
The derivation cohort included 4867 consecutive ED patients admitted during 2009 to 2011. The validation cohort comprised 3229 patients admitted in 2014.
Measurements
88 candidate risk factors and 30-day mortality.
Results
Thirteen independent risk factors were identified in the derivation cohort and were combined into an overall score, the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score. This score predicted 30-day mortality with excellent discrimination (c-statistic, 0.836) and calibration (Hosmer-Lemeshow P = 0.99) and provided a steep gradient in 30-day mortality across risk groups (<2% for patients in the 2 lowest risk quintiles and 45% in the highest risk decile). These characteristics were confirmed in the validation cohort (c-statistic, 0.828). Multiple sensitivity analyses did not find important amounts of confounding or bias.
Limitations
The study was confined to a single country. Participating EDs were not selected randomly. Many patients had missing data. Measurement of some risk factors was subjective.
Conclusion
This tool has excellent discrimination and calibration and was validated in a…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 4,867 participants or records.
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