Evaluation of the HEFESTOS scale to predict outcomes in emergency department acute heart failure patients

Abstract The HEFESTOS scale was developed in 14 Spanish primary care centres and validated in 9 primary care centres of other European countries. It showed good performance to predict death/hospitalisation during the first 30 days after an episode of acute heart failure (AHF), with c-statistics of 0.807/0.730 in the derivation/validation cohorts. We evaluated this scale in the emergency department (ED) setting, comparing it to the EHMRG and MEESSI scales in the ED and the EFFECT and GWTG scales in hospitalised patients, to predict 30-day outcomes, including death and hospitalisation. Consecutive AHF patients were enrolled in 34 Spanish EDs in January–February 2016, 2018, and 2019 with variables needed to calculate outcome scores. Thirty-day hospitalisation/death (together and separately) and post-discharge combined adverse event (ED revisit or hospitalisation for AHF or all-cause death) were determined for patients discharged home after ED care. Predictive capacity was assessed by c-statistic with 95% confidence intervals. Of 10,869 patients, 4,044 were included (median age: 83 years, 54% women). The performance of HEFESTOS was modest for 30-day hospitalisation/death, c-statistic=0.656 (0.637-0.675), hospitalisation, 0.650 (0.631-0.669), and death, 0.610 (0.576-0.644). Of 1,034 patients with scores for the 5 scales, HEFESTOS had the numerically highest c-statistic for hospitalisation/death at 30 days, 0.666 (0.627-0.704), vs. MEESSI= 0.650 (0.612-0.687, p=0.51), EFFECT=0.633 (0.595-0.672, p=0.21), GWTG=0.618 (0.578-0.657, p=0.06) and EHMRG=0.617 (0.577-0.704, p=0.07). Similar modest performances were observed for predicting hospitalisation [ranging from HEFESTOS=0.656 (0.618-0.695) to GWTG=0.603 (0.564-0.643)]. Conversely, prediction of 30-day death was good with the MEESSI=0.787 (0.728-845), EFFECT=0.754 (0.691-0.818) and GWTG=0.749 (0.689-0.809) scales, and modest with EHMRG=0.649 (0.581-0.717) and HEFESTOS=0.610 (0.538-0.683). Although the HEFESTOS scale was numerically better for predicting 30-day hospitalisation/death in ED AHF patients, its modest performance precludes routine use. Only 30-day mortality was adequately predicted by some scales, with the MEESSI achieving the best results..

Medienart:

E-Artikel

Erscheinungsjahr:

2022

Erschienen:

2022

Enthalten in:

Zur Gesamtaufnahme - volume:17

Enthalten in:

Internal and emergency medicine - 17(2022), 7 vom: 29. Aug., Seite 2129-2140

Sprache:

Englisch

Beteiligte Personen:

Gil-Rodrigo, Adriana [VerfasserIn]
Verdú-Rotellar, José María [VerfasserIn]
Gil, Víctor [VerfasserIn]
Alquézar, Aitor [VerfasserIn]
Llauger, Lluís [VerfasserIn]
Herrero-Puente, Pablo [VerfasserIn]
Jacob, Javier [VerfasserIn]
Abellana, Rosa [VerfasserIn]
Muñoz, Miguel-Ángel [VerfasserIn]
López-Díez, María-Pilar [VerfasserIn]
Ivars-Obermeier, Nicole [VerfasserIn]
Espinosa, Begoña [VerfasserIn]
Rodríguez, Beatriz [VerfasserIn]
Fuentes, Marta [VerfasserIn]
Tost, Josep [VerfasserIn]
López-Grima, M. Luisa [VerfasserIn]
Romero, Rodolfo [VerfasserIn]
Müller, Christian [VerfasserIn]
Peacock, WFrank [VerfasserIn]
Llorens, Pere [VerfasserIn]
Miró, Òscar [VerfasserIn]

Links:

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BKL:

44.80$jUnfallmedizin$jNotfallmedizin

Themen:

Acute heart failure
Emergency departments
Hospitalisation
Mortality
Prognosis
Prognostication
Scales
Scores

Anmerkungen:

© The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI) 2022. Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

doi:

10.1007/s11739-022-03068-9

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2132220859

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