Patients with acute heart failure discharged from the emergency department and classified as low risk by the MEESSI score (multiple risk estimate based on the Spanish emergency department scale): prevalence of adverse events and predictability
Por:
Miro, O, Gil, V, Rossello, X, Martin-Sanchez, FJ, Llorens, P, Jacob, J, Herrero, P, Mateo, SH, Richard, F, Escoda, R, Fuentes, M, Mojarro, EM, Llauger, L, Bueno, H, Pocock, S, Gil, C, Garmila, P, Adrada, ER, Perdigones, J, Escobar, L, Xipell, C, Sanchez, C, Gaytan, JM, Perez-Dura, MJ, Pavon, J, Alvarez, AB, Noval, A, Torres, JM, Lopez-Grima, ML, Valero, A, Juan, MAE, Aguirre, A, Pedragosa, MA, Alonso, MI, Ruiz, F, Franco, JM, Diaz, E, Mecina, AB, Tost, J, Sanchez, S, Pinera, P, Garate, RT, Rizzi, MA, Herrera, S, Cabello, I, Perez, JMA, Diez, MPL, Alvarez, JV, Morilla, AA, Irimia, A, Marquina, V, Jimenez, I, Hernandez, N, Ramos, S, Lopez, A, Andueza, JA, Romero, R, Calvache, R, Lorca, MT, Calderon, L, Arriaga, BA, Sierra, B, Becquer, LT, La Salle, GC, Urbano, CA, Ferrer, ES
Publicada:
1 feb 2019
Resumen:
Objective. To determine the rate of adverse events in patients with acute heart failure (AHF) who were discharged from the emergency department (ED) after classification as low risk according to MEESSI score (multiple risk estimate based on the Spanish ED scale), to analyze the ability of the score to predict events, and to explore variables associated with adverse events.
Methods. Patients in the EAHFE registry (Epidemiology of Acute Heart Failure in EDs) were stratified according to risk indicated by MEESSI score in order to identify those considered at low risk on discharge. All-cause 30-day mortality and revisits related to AHF within 7 days and 30 days were recorded. The area under the receiver operating characteristic curve (AUC) was calculated for the MEESSI score's ability to predict these events. Associations between 42 variables and 7-day and 30-day revisits to the ED were analyzed by multivariable logistic regression.
Results. A total of 1028 patients were included. The 30-day mortality rate was 1.6% (95% CI, 0.9%-2.5%). The 7-day and 30-day revisit rates were 8.0% (95% CI, 6.4%-9.8%) and 24.7% (95% CI, 22.1%-25.7%), respectively. The AUCs for MEESSI score discrimination between patients with and without these outcomes were as follows: 30-day mortality, 0.69 (95% CI, 0.58-0.80); 7-day revisiting, 0.56 (95% CI, 0.49-0.63); and 30-day revisiting, 0.54 (95% CI, 0.50-0.59). Variables associated with 7-day revisits were long-term diuretic treatment (odds ratio [OR], 2.45; 95% CI, 1.01-5.98), hemoglobin concentration less than 110 g/L (OR, 1.68; 95% CI, 1.02-2.75), and intravenous diuretic treatment in the ED (OR, 0.53; 95% CI, 0.31-0.90). Variables associated with 30-day revisits were peripheral artery disease (OR, 1.74; 95% CI, 1.01-3.00), prior history of an AHF episode (OR, 1.42; 95% CI, 1.02-1.98), long-term mineralocorticoid receptor antagonist treatment (OR, 1.71; 95% CI, 1.09-2.67), Barthel index less than 90 points in the ED (OR, 1.48; 95% CI, 1.07-2.06), and intravenous diuretic treatment in the ED (OR, 0.58; 95% CI, 0.40-0.84).
Conclusions. Patients with AHF who are at low risk for adverse events on discharge from our EDs have event rates that are near internationally recommended targets. The MEESSI score, which was designed to predict 30-day mortality, is a poor predictor of 7-day or 30-day revisiting in these low-risk patients. We identified other factors related to these events.
Filiaciones:
Miro, O:
IDIBAPS, Grp Invest Urgencias Proc & Patol, Barcelona, Spain
Univ Barcelona, Fac Med, Barcelona, Spain
Hosp Clin Barcelona, Area Urgencias, Villarroel 170, Barcelona 08036, Spain
Gil, V:
Hosp Clin Barcelona, Area Urgencias, Villarroel 170, Barcelona 08036, Spain
IDIBAPS, Grp Invest Urgencias Proc & Patol, Barcelona, Spain
Rossello, X:
CIBER Enfermedades Cardiovasc, Madrid, Spain
CNIC, Madrid, Spain
London Sch Hyg & Trop Med, Dept Med Stat, London, England
Martin-Sanchez, FJ:
Hosp Clin San Carlos, Serv Urgencias, Madrid, Spain
Univ Complutense, Hosp Clin San Carlos, IDISSC, Madrid, Spain
Llorens, P:
Univ Miguel Hernandez, Hosp Gen Alicante, Serv Urgencias Corta Estancia & Hosp Domicilio, Alicante, Spain
Jacob, J:
Hosp Univ Bellvitge, Serv Urgencias, Barcelona, Spain
Herrero, P:
Hosp Univ Cent Asturias, Serv Urgencias, Oviedo, Spain
Mateo, SH:
Hosp Santa Creu & Sant Pau, Serv Urgencias, Barcelona, Spain
Richard, F:
Hosp Univ Burgos, Serv Urgencias, Burgos, Spain
Escoda, R:
Hosp Clin Barcelona, Area Urgencias, Villarroel 170, Barcelona 08036, Spain
IDIBAPS, Grp Invest Urgencias Proc & Patol, Barcelona, Spain
Fuentes, M:
Hosp Univ Salamanca, Serv Urgencias, Salamanca, Spain
Mojarro, EM:
Hosp St Pau & Santa Tecla, Serv Urgencias, Tarragona, Spain
Llauger, L:
Hosp Univ Vic, Serv Urgencias, Barcelona, Spain
Bueno, H:
Hosp Univ 12 Octubre, Serv Cardiol, Madrid, Spain
Pocock, S:
London Sch Hyg & Trop Med, Dept Med Stat, London, England
CNIC, Madrid, Spain
Gil, C:
Hosp Univ Salamanca, Salamanca, Spain
Garmila, P:
Hosp Marques Valdecilla, Santander, Spain
Adrada, ER:
Hosp Clin San Carlos, Madrid, Spain
Perdigones, J:
Hosp Clin San Carlos, Madrid, Spain
Escobar, L:
Hosp Clin San Carlos, Madrid, Spain
Xipell, C:
Hosp Clin Barcelona, Barcelona, Spain
Sanchez, C:
Hosp Clin Barcelona, Barcelona, Spain
Gaytan, JM:
Hosp Clin Barcelona, Barcelona, Spain
Perez-Dura, MJ:
Hosp La Fe Valencia, Valencia, Spain
Pavon, J:
Hosp Dr Negrin Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Alvarez, AB:
Hosp Dr Negrin Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Noval, A:
Hosp Insiular Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain
Torres, JM:
Hosp Reina Sofia Cordoba, Cordoba, Spain
Lopez-Grima, ML:
Hosp Dr Peset de Valencia, Valencia, Spain
Valero, A:
Hosp Dr Peset de Valencia, Valencia, Spain
Juan, MAE:
Hosp Dr Peset de Valencia, Valencia, Spain
Aguirre, A:
Hosp del Mar Barcelona, Barcelona, Spain
Pedragosa, MA:
Hosp del Mar Barcelona, Barcelona, Spain
Alonso, MI:
Hosp Valme Sevilla, Seville, Spain
Ruiz, F:
Hosp Valme Sevilla, Seville, Spain
Franco, JM:
Hosp Miguel Servet Zaragoza, Zaragoza, Spain
Diaz, E:
Hosp San Juan Alicante, Alicante, Spain
Mecina, AB:
Hosp Alcorcon, Madrid, Spain
Tost, J:
Consorci Sanitari Terrassa, Barcelona, Spain
Sanchez, S:
Hosp Rio Ortega Valladolid, Valladolid, Spain
Pinera, P:
Hosp Reina Sofia Murcia, Murcia, Spain
Garate, RT:
Hosp Severo Ochoa, Madrid, Spain
Rizzi, MA:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Herrera, S:
Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain
Cabello, I:
Hosp Univ Bellvitge, Barcelona, Spain
Perez, JMA:
Hosp Univ Burgos, Burgos, Spain
Diez, MPL:
Hosp Univ Burgos, Burgos, Spain
Alvarez, JV:
Hosp Univ Cent Asturias, Oviedo, Asturias, Spain
Morilla, AA:
Hosp Univ Cent Asturias, Oviedo, Asturias, Spain
Irimia, A:
Hosp Univ Cent Asturias, Oviedo, Asturias, Spain
Marquina, V:
Hosp Gen Alicante, Alicante, Spain
Jimenez, I:
Hosp Gen Alicante, Alicante, Spain
Hernandez, N:
Hosp Gen Alicante, Alicante, Spain
Ramos, S:
Hosp Gen Alicante, Alicante, Spain
Lopez, A:
Hosp Gen Alicante, Alicante, Spain
Andueza, JA:
Hosp Gen Univ Gregorio Maranon Madrid, Madrid, Spain
Romero, R:
Hosp Getafe Madrid, Madrid, Spain
Calvache, R:
Hosp Henares Madrid, Madrid, Spain
Lorca, MT:
Hosp Tajo Madrid, Madrid, Spain
Calderon, L:
Hosp Tajo Madrid, Madrid, Spain
Arriaga, BA:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Sierra, B:
Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain
Becquer, LT:
Hosp Univ Canarias Tenerife, Tenerife, Spain
La Salle, GC:
Hosp Univ Vic Barcelona, Barcelona, Spain
Urbano, CA:
Hosp Costa Sol Marbella, Malaga, Spain
Ferrer, ES:
Hosp Josep Trueta Girona, Girona, Spain
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