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Rev Esp Cardiol (Engl Ed). 2019 Mar;72(3):198-207. doi: 10.1016/j.rec.2018.05.002. Epub 2018 Jun 11.

The Usefulness of the MEESSI Score for Risk Stratification of Patients With Acute Heart Failure at the Emergency Department.

[Article in English, Spanish]

Author information

1
Servicio de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain. Electronic address: omiro@clinic.cat.
2
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
3
Servicio de Urgencias, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
4
Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
5
Servicio de Urgencias, Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Hospital General de Alicante, Alicante, Spain.
6
Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
7
Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
8
Servicio de Urgencias, Hospital Doctor Peset, Valencia, Spain.
9
Servicio de Urgencias, Hospital Universitario de Salamanca, Salamanca, Spain.
10
Servicio de Urgencias, Hospital Universitario de Albacete, Albacete, Spain.
11
Servicio de Urgencias, Hospital Virgen de la Macarena, Sevilla, Spain.
12
Servicio de Urgencias, Hospital Universitario La Fe, Valencia, Spain.
13
Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain.
14
Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Departamento de Cardiología, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

The MEESSI scale stratifies acute heart failure (AHF) patients at the emergency department (ED) according to the 30-day mortality risk. We validated the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings.

METHODS:

We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016. The MEESSI score was calculated for each patient. The c-statistic measured the discriminatory capacity to predict 30-day mortality of the full MEESSI model and secondary models. Further comparisons were made among subgroups of patients from university and community hospitals, EDs with high-, medium- or low-activity and EDs that recruited or not patients in the original MEESSI derivation cohort.

RESULTS:

We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low risk, 2023 (42.9%) intermediate risk, 530 (11.3%) high risk and 485 (10.3%) very high risk, with 30-day mortality of 2.0%, 7.8%, 17.9%, and 41.4%, respectively. The c-statistic for the full model was 0.810 (95%CI, 0.790-0.830), ranging from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs.

CONCLUSIONS:

The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients.

KEYWORDS:

Acute heart failure; Emergency department; Escala de riesgo; Estratificación de riesgo; Evolución; Insuficiencia cardiaca aguda; Mortalidad; Mortality; Outcome; Risk score; Risk stratification; Servicios de urgencias hospitalarios

PMID:
29903688
DOI:
10.1016/j.rec.2018.05.002
[Indexed for MEDLINE]

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