Emergency Heart failure Mortality Risk Grade may help to reduce heart failure admissions
N E van Hattem, S L M A Beeres, B J A Mertens, M L Antoni, D E Atsma, M J Schalij, M C den Haan, N E van Hattem, S L M A Beeres, B J A Mertens, M L Antoni, D E Atsma, M J Schalij, M C den Haan
Abstract
Introduction: Hospital admissions for heart failure (HF) are frequent and pose a heavy burden on health care resources. Currently, the decision to hospitalise is based on clinical judgement rather than on prognostic risk stratification. The Emergency Heart failure Mortality Risk Grade (EHMRG) was recently developed to identify high-risk HF patients in the emergency department (ED).
Objective: To assess the ability of the EHMRG to predict 30-day mortality in Dutch HF patients visiting the ED and to evaluate whether the EHMRG could help to reduce the number of hospital admissions for decompensated HF.
Methods: Patients visiting the ED for decompensated HF were included. The decision to hospitalise or discharge was based on clinical judgement. The EHMRG was calculated retrospectively. Based on their EHMRG, patients were stratified as very low risk, low risk, intermediate risk, high risk and very high risk.
Results: In 227 patients (age 73 ± 12 years, 69% male) 30-day mortality was 11%. Mortality differed significantly among the EHMRG risk groups at 7‑day (p = 0.012) and 30-day follow-up (p < 0.01). Based on clinical judgement, 76% of patients were hospitalised. If decision-making had been based on EHMRG, the hospitalisation rate could have been reduced to 66% (p < 0.01), particularly by reducing hospitalisations in patients at low risk of death. Mortality in discharged patients, whether the decision was based on EHMRG or clinical judgement, was 0%.
Conclusion: The EHMRG accurately differentiates between high- and low-risk decompensated HF patients visiting the ED, making it a promising tool to safely reduce the number of HF admissions.
Keywords: Emergency department; Heart failure; Hospitalisation; Mortality; Risk assessment.
Conflict of interest statement
N.E. van Hattem, S.L.M.A. Beeres, B.J.A. Mertens, M.L. Antoni, D.E. Atsma, M.J. Schalij and M.C. den Haan declare that they have no competing interests.
© 2022. The Author(s).
Figures
References
- Hartstichting NL. Feiten en cijfers hart en vaatziekten. 2019. . Accessed 1 Nov 2019.
- Ponikowski P, et al. Heart failure: preventing disease and death worldwide. ESC Heart Fail. 2014;1:4–25. doi: 10.1002/ehf2.12005.
- Lee DS, et al. Early deaths in patients with heart failure discharged from the emergency department: a population-based analysis. Circ Heart Fail. 2010;3:228–235. doi: 10.1161/CIRCHEARTFAILURE.109.885285.
- Lee DS, Lee JS, Schull MJ, et al. Prospective validation of the Emergency Heart failure Mortality Risk Grade for acute heart failure. Circulation. 2019;139:1146–1156. doi: 10.1161/CIRCULATIONAHA.118.035509.
- Lee DS, Stitt A, Austin PC, et al. Prediction of heart failure mortality in emergent care: a cohort study. Ann Intern Med. 2012;156:767–775. doi: 10.7326/0003-4819-156-11-201206050-00003.
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail. 2016;18:891–975. doi: 10.1002/ejhf.592.
- Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev. 2017;3:7–11. doi: 10.15420/cfr.2016:25:2.
- Michaud AM, et al. Prediction of early adverse events in emergency department patients with acute heart failure: a systematic review. Can J Cardiol. 2018;34:168–179. doi: 10.1016/j.cjca.2017.09.004.
- Gil V, Miro O, Schull MJ, et al. 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. Eur J Emerg Med. 2018;25:169–177. doi: 10.1097/MEJ.0000000000000422.
- Buckley LF, et al. Intravenous diuretic therapy for the management of heart failure and volume overload in a multidisciplinary outpatient unit. JACC Heart Fail. 2016;4:1–8. doi: 10.1016/j.jchf.2015.06.017.
- Inglis SC, et al. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015;10:CD007228.
Source: PubMed