In the Journals

MEESSI-AHF score predicts mortality in acute heart failure

Desiree Wussler 2019
Desiree Wussler

A risk stratification score known as Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF, or MEESSI-AHF, accurately estimated 30-day mortality among Swiss patients hospitalized for acute heart failure, according to data published in Annals of Internal Medicine.

“As most acute heart failure (AHF) patients present to the ED for initial treatment, an early risk stratification is of crucial importance in order to decide whether to hospitalize a patient or even treat him in an intensive care unit setting,” Desiree Wussler, MD, from University Hospital Basel, Switzerland, told Healio Primary Care Today.

The MEESSI-AHF score was validated in Spain for predicting 30-day mortality in patients presenting to the ED with AHF, but how it performs in other countries is unknown, according to the researchers.

Wussler and colleagues conducted a prospective cohort study to determine if the MEESSI-AHF score was effective in a cohort of patients admitted to EDs in Switzerland for AHF (n = 1,247; median age, 79 years; 42.2% women).

The researchers calculated participants’ MEESSI-AHF score by using an established model that assessed 12 independent risk factors. Participants were categorized into six groups based on their predicted likelihood of death, ranging from low to high risk.

The median length of hospital stay was 11 days. About 8% of participants died within 30 days.

The score demonstrated “excellent discrimination” in predicting 30-day mortality, according to the researchers.

There was a significant difference in the risk for 30-day mortality between the groups, ranging from 0% in the lowest-risk group to 28.5% in the highest-risk group.

The MEESSI-AHF score overestimated the risk of AHF in the high-risk groups; however, after adjusting the intercept, predicted risks and observed outcomes showed agreement.

Sensitivity analyses confirmed these results.

“The MEESSI score seems to be a highly promising tool for risk stratification of AHF patients in the ED,” Wussler said. “However, there is a potential need for recalibration whenever introducing this score to a new population.”

“The ideal procedure would be to first recalibrate the MEESSI score according to the pertaining populations outcome frequencies and then to integrate the updated score into the already established online calculator,” she said. “Afterwards, patients could be easily stratified into different risk groups according to their MEESSI score. This would a allow a standardized risk stratification and facilitate the following decision: Do we have to hospitalize the pertaining patients or even treat him in an intensive care unit setting?”

“An important first step would be a clinical trial in order to further characterize the clinical implications of the MEESSI score and maybe discover further application areas,” she added. – by Alaina Tedesco

 

Disclosures: Wussler reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.

 

Desiree Wussler 2019
Desiree Wussler

A risk stratification score known as Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF, or MEESSI-AHF, accurately estimated 30-day mortality among Swiss patients hospitalized for acute heart failure, according to data published in Annals of Internal Medicine.

“As most acute heart failure (AHF) patients present to the ED for initial treatment, an early risk stratification is of crucial importance in order to decide whether to hospitalize a patient or even treat him in an intensive care unit setting,” Desiree Wussler, MD, from University Hospital Basel, Switzerland, told Healio Primary Care Today.

The MEESSI-AHF score was validated in Spain for predicting 30-day mortality in patients presenting to the ED with AHF, but how it performs in other countries is unknown, according to the researchers.

Wussler and colleagues conducted a prospective cohort study to determine if the MEESSI-AHF score was effective in a cohort of patients admitted to EDs in Switzerland for AHF (n = 1,247; median age, 79 years; 42.2% women).

The researchers calculated participants’ MEESSI-AHF score by using an established model that assessed 12 independent risk factors. Participants were categorized into six groups based on their predicted likelihood of death, ranging from low to high risk.

The median length of hospital stay was 11 days. About 8% of participants died within 30 days.

The score demonstrated “excellent discrimination” in predicting 30-day mortality, according to the researchers.

There was a significant difference in the risk for 30-day mortality between the groups, ranging from 0% in the lowest-risk group to 28.5% in the highest-risk group.

The MEESSI-AHF score overestimated the risk of AHF in the high-risk groups; however, after adjusting the intercept, predicted risks and observed outcomes showed agreement.

Sensitivity analyses confirmed these results.

“The MEESSI score seems to be a highly promising tool for risk stratification of AHF patients in the ED,” Wussler said. “However, there is a potential need for recalibration whenever introducing this score to a new population.”

“The ideal procedure would be to first recalibrate the MEESSI score according to the pertaining populations outcome frequencies and then to integrate the updated score into the already established online calculator,” she said. “Afterwards, patients could be easily stratified into different risk groups according to their MEESSI score. This would a allow a standardized risk stratification and facilitate the following decision: Do we have to hospitalize the pertaining patients or even treat him in an intensive care unit setting?”

“An important first step would be a clinical trial in order to further characterize the clinical implications of the MEESSI score and maybe discover further application areas,” she added. – by Alaina Tedesco

 

Disclosures: Wussler reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.