Evaluation of the HEFESTOS scale to predict outcomes in emergency department acute heart failure patients
Por:
Gil-Rodrigo, A, Verdu-Rotellar, JM, Gil, V, Alquezar, A, Llaugers, L, Herrero-Puente, P, Jacob, J, Abellana, R, Munoz, MA, Lopez-Diez, MP, Ivars-Obermeier, N, Espinosa, B, Rodriguezl, B, Fuentes, M, Tost, J, Lopez-Grima, ML, Romero, R, Muler, C, Peacock, W, Llorens, P, Miro, O
Publicada:
1 oct 2022
Ahead of Print:
1 ago 2022
Resumen:
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.
Filiaciones:
Gil-Rodrigo, A:
Dr Balmis Gen Univ Hosp, Emergency Dept, Short Stay Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Dr Balmis Gen Univ Hosp, Hospitalizat Home Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Verdu-Rotellar, JM:
Pompeu Fabra Univ, Catalan Inst Hlth, Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport Recerca Barcelona, Barcelona, Spain
Gil, V:
Univ Barcelona, Inst Invest Biomed August Pi I Sunyer IDIBAPS, Emergency Dept, Clin Barcelona Hosp Univ, C Villarroel 170, Barcelona 08036, Catalonia, Spain
Alquezar, A:
Hosp Santa Creu & Sant Pau, Emergency Dept, Barcelona, Spain
Llaugers, L:
Hosp Univ Vic, Emergency Dept, Barcelona, Catalonia, Spain
Herrero-Puente, P:
Cent Univ Hosp Asturias, Emergency Dept, Oviedo, Spain
Jacob, J:
Hosp Univ Bellvitge, Emergency Dept, Barcelona, Catalonia, Spain
Abellana, R:
Univ Barcelona, Med Sch, Unitat Bioestadist, Dept Fonaments Clin, Barcelona, Catalonia, Spain
Munoz, MA:
Pompeu Fabra Univ, Catalan Inst Hlth, Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport Recerca Barcelona, Barcelona, Spain
Lopez-Diez, MP:
Healthcare Univ Complex Burgos, Emergency Dept, Burgos, Spain
Ivars-Obermeier, N:
Dr Balmis Gen Univ Hosp, Emergency Dept, Short Stay Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Dr Balmis Gen Univ Hosp, Hospitalizat Home Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Espinosa, B:
Dr Balmis Gen Univ Hosp, Emergency Dept, Short Stay Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Dr Balmis Gen Univ Hosp, Hospitalizat Home Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Rodriguezl, B:
Infanta Leonor Univ Hosp, Emergency Dept, Madrid, Spain
Fuentes, M:
Univ Hosp Salamanca, Emergency Dept, Salamanca, Spain
Tost, J:
Consorci Hospitalari Terrassa, Emergency Dept, Barcelona, Catalonia, Spain
Lopez-Grima, ML:
Doctor Peset Univ Hosp, Emergency Dept, Valencia, Spain
Romero, R:
Univ Europea, Univ Hosp Getafe, Emergency Dept, Madrid, Spain
Muler, C:
Univ Hosp Basel, Cardiovasc Res Inst Basel, Cardiol Dept, Basel, Switzerland
GREAT Network, Rome, Italy
Peacock, W:
Baylor Sch Med, Emergency Dept, Houston, TX USA
GREAT Network, Rome, Italy
Llorens, P:
Dr Balmis Gen Univ Hosp, Emergency Dept, Short Stay Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Dr Balmis Gen Univ Hosp, Hospitalizat Home Unit, Alicante Inst Hlth & Biomed Res ISABIAL, Alicante, Spain
Miro, O:
Univ Barcelona, Inst Invest Biomed August Pi I Sunyer IDIBAPS, Emergency Dept, Clin Barcelona Hosp Univ, C Villarroel 170, Barcelona 08036, Catalonia, Spain
GREAT Network, Rome, Italy
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