Emergency Heart Failure Mortality Risk Grade score performance for 7-day mortality prediction in patients with heart failure attended at the emergency department: validation in a Spanish cohort
Por:
Gil V, Miro O, Schull MJ, Llorens P, Herrero P, Jacob J, Rios J, Lee DS, Martin-Sanchez FJ and ICA-SEMES Research Group
Publicada:
1 jun 2018
Ahead of Print:
10 sep 2016
Categoría:
Emergency medicine
Resumen:
Objective The Emergency Heart Failure Mortality Risk Grade (EHMRG)
scale, derived in 86 Canadian emergency departments (EDs), stratifies
patients with acute-decompensated heart failure (ADHF) according to
their 7-day mortality risk. We evaluated its external validity in a
Spanish cohort.
Patients and methods We applied the EHMRG scale to ADHF patients
consecutively included in the Epidemiology of Acute Heart Failure in
Emergency departments (EAHFE) registry (29 Spanish EDs) and measured its
performance. Patients were distributed into quintiles according to the
original and their self-defined score cutoffs. The 7-day mortality rates
were compared internally among different categories and with categories
of Canadian cohorts.
Results The EAHFE group [n: 1553 patients; 80 (10) years; 55.6% women]
had a 5.5% 7-day mortality rate and the EHMRG scale c-statistic was
0.741 (95% confidence interval: 0.688-0.793) compared with 0.807
(0.761-0.842) and 0.804 (0.763-0.840) obtained in the Canadian
derivation and validation cohorts. The mortality rate of the EAHFE group
mortality increased progressively as the quintile categories increased
using intervals defined by either the Canadian or the Spanish EHMRG
score cutoffs, although with more regular increments with the
EAHFE-defined intervals; using the latter, patients at quintiles 2, 3,
4, 5a and 5b had (compared with quintile 1) odds ratios of 1.77, 3.36,
4.44, 9.39 and 16.19, respectively.
Conclusion The EHMRG scale stratified risk in an ADHF cohort that
included both palliative and nonpalliative patients in Spanish EDs,
showing an extrapolation to a higher mortality risk cohort than the
original derivation sample. Stratification improved when the score was
recalibrated in the Spanish cohort. Copyright (C) 2018 Wolters Kluwer
Health, Inc. All rights reserved.
Filiaciones:
Gil V:
aEmergency Department, Hospital Clinic b'Emergencies: Processes and Pathologies' Research Group cBiostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic dEmergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat eBiostatistics Unit, Faculty of Medicine, Universitat Autonoma de Barcelona, Barcelona fEmergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante gEmergency Department, Hospital Universitario Centr
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