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Emerg Med J. 2012 Dec;29(12):e5. doi: 10.1136/emermed-2011-200610. Epub 2011 Dec 8.

Validating the acute heart failure index for patients presenting to the emergency department with decompensated heart failure.

Author information

1
Emergency Department, Sharp Grossmont Hospital, San Diego, California, USA. james_j_hsiao@yahoo.com

Abstract

BACKGROUND:

The acute heart failure index (AHFI) is a previously derived prediction rule to identify patients presenting to emergency departments (ED) with decompensated heart failure (DHF) at low risk of early life-threatening events.

STUDY OBJECTIVES:

To validate the AHFI prospectively.

METHODS:

Using a prospective cohort study, adult patients presenting to an urban university hospital ED with DHF were included. Data on 21 variables were gathered to calculate the AHFI. Primary endpoints included inpatient death and non-fatal serious outcomes (myocardial infarction, ventricular fibrillation, cardiogenic shock, cardiac arrest, intubation, or cardiac reperfusion). Secondary endpoints included death from any cause or readmission for heart failure within 30 days. Primary and secondary endpoint rates were calculated with 95% CI for the low and higher-risk subgroups.

RESULTS:

259 patients were enrolled. 245/259 (95%) were admitted. 60/259 (23%) met low-risk criteria, of whom 1/60 (1.7%, CI 0.04 to 8.9) was discharged after sustaining pulseless electrical activity arrest. The comparable primary outcome rate in the derivation study was 1.4% (CI 1.1 to 1.7). 17/199 (8.5%, CI 5.1 to 13.3) higher-risk patients experienced an endpoint, compared with 13.3% (CI 12.9 to 13.7) in the derivation cohort. One low-risk patient (1.7%, CI 0.04 to 8.9) died within 30 days, and five (8.3%, CI 2.8 to 18.4) were readmitted. Corresponding rates in the derivation study were 2% and 5%, respectively.

CONCLUSION:

The results are consistent with those previously reported for the low-risk subgroup of the AHFI. Further research is needed to determine the impact, safety and full range of generalisability of the AHFI as an adjunct to decision making.

PMID:
22158534
PMCID:
PMC3698980
DOI:
10.1136/emermed-2011-200610
[Indexed for MEDLINE]
Free PMC Article

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