Abstract 11062: Acute Heart Failure (HF) Mortality Prediction in Emergent Care: The Emergency Heart Failure Mortality Risk Grade
BACKGROUND: Despite the substantial resource and economic implications of hospitalization of the patient with HF, the decision to admit or discharge patients is often not guided by evidence. The objective of this study was to derive and validate a risk model for acute mortality prediction in HF patients who present to the emergency department (ED).
METHODS: We examined 12,591 patients with acute HF who presented to the ED from 2004 to 2007 in Ontario, Canada. The cohort was comprised of patients who were either admitted to hospital or discharged home in a 2:1 ratio. We derived and validated a risk score for prediction of 7-day death using only readily-available clinical factors.
RESULTS: In the derivation (n=7433, 75.4±11.4 yr, 52% men) and validation (n=5158, 75.7±11.4 yr, 52% men) cohorts, overall 7-day mortality rate was 2.0%. Mortality risk increased with higher heart rate (adjusted odds ratio [aOR] 1.15 per 10 beats/min; p=0.017) and creatinine (aOR 1.35 per 1 mg/dL; p<0.001), with lower systolic blood pressure (aOR 1.52 per 20 mmHg; p<0.001) and lower oxygen saturation (aOR 1.16 per 5%, p=0.033). Detectable serum troponin (aOR 2.75; p<0.001) and metolazone use (aOR 2.65; p=0.036) were also associated with mortality. Areas under the receiver operating characteristic curves of the multivariable model were 0.805 in the derivation set and 0.811 after bootstrap-correction. The c-statistic was 0.826 in the external validation dataset. A multivariable index score stratified 7-day mortality with rates of 0.3%, 0.3%, 0.7%, and 1.9% in quintiles 1 to 4. Mortality rates in the two highest risk deciles comprising quintile 5 were 3.5% and 8.2%. Among those discharged from the ED, 7-day mortality in the 2 lowest risk quantiles was 0.2%. The ORs in the 2 highest risk deciles were 8.32 (decile 9: 95%CI; 2.19-33.78, p<0.01) and 21.29 (decile 10: 95%CI; 6.36-81.99, p<0.001). Among admitted patients, 7-day mortality in the 2 lowest risk quantiles was 0.4%, and the ORs in the 2 highest risk deciles were 9.72 (decile 9: 95%CI; 5.25-19.40, p<0.001) and 23.52 (95%CI; 13.47-45.16, p<0.001).
CONCLUSIONS: A simple clinical risk model can predict acute mortality among HF patients who present to the ED with high accuracy and may guide admission vs. discharge decision-making.
- © 2011 by American Heart Association, Inc.