New ED Heart Failure Score Identifies Low-Risk Patients

Summary and Comment |
October 6, 2017

New ED Heart Failure Score Identifies Low-Risk Patients

  1. Ali S. Raja, MD, MBA, MPH

But with 22 data points needed to calculate the score, uptake may be low.

  1. Ali S. Raja, MD, MBA, MPH

Most emergency department (ED) patients with heart failure (HF) are admitted to inpatient units, resulting in significant resource utilization. Many of these patients are discharged quickly, indicating the need for tools that can discriminate between ED patients who truly need admission and those who might safely be discharged to follow-up with their own physicians after treatment and stabilization in the ED. These researchers derived and validated a decision tool for exactly this purpose.

They evaluated 88 candidate variables to derive a score for predicting 30-day mortality in a prospective cohort of roughly 4900 patients with HF at 34 EDs in Spain from 2009 to 2011, and validated the score in a cohort of 3200 patients in 2014. The final tool consisted of 13 variables, among them hypertrophy on electrocardiogram, creatinine level, and the 10-item Barthel Index of Activities of Daily Living. The score successfully identified both high-risk and low-risk patients, showing excellent discrimination (c-statistic, 0.83) for identifying the 10% of patients with approximately 45% risk of 30-day mortality as well as the 40% of patients with <2% risk.

Comment

If the necessary outpatient resources are available, it would be wonderful to safely discharge 40% of ED patients with HF. However, scores are only as useful as their ease of calculation, and this one is not at all easy. That being said, the days of asking providers to memorize applicable scores and calculate them is over. We must embed robust clinical decision support tools and prescriptive intelligence into the electronic medical record if there is any potential for utility and accuracy of use in a busy ED.

Editor Disclosures at Time of Publication

  • Disclosures for Ali S. Raja, MD, MBA, MPH at time of publication Leadership positions in professional societies Society for Academic Emergency Medicine (Board Member)

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