Performance of Emergency Heart Failure Mortality Risk Grade in the Emergency Department
| Autor: | Lance B. Becker, Pridha Kumar, Adan Z. Becerra, N. Garg, Phillip D. Levy, Renee Pekmezaris, Ghania Haddad, Andrzej Kozikowski, Gerin Stevens, Vidhi Patel |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Emergency Medical Services medicine.medical_specialty Palliative care Critical Care Exacerbation Population New York Interquartile range Clinical Decision Rules Emergency medical services medicine Humans education Original Research Aged Retrospective Studies Aged 80 and over Heart Failure education.field_of_study RC86-88.9 business.industry Do not resuscitate Medical emergencies. Critical care. Intensive care. First aid Retrospective cohort study General Medicine Emergency department Middle Aged Hospitalization Logistic Models Emergency medicine Emergency Medicine Medicine Emergency Service Hospital business |
| Zdroj: | Western Journal of Emergency Medicine Western Journal of Emergency Medicine, Vol 22, Iss 3 (2021) |
| ISSN: | 1936-900X |
| DOI: | 10.5811/westjem.2021.1.48978 |
| Popis: | Introduction: The purpose of this study was to validate and assess the performance of the Emergency Heart Failure Mortality Risk Grade (EHMRG) to predict seven-day mortality in US patients presenting to the emergency department (ED) with acute congestive heart failure (CHF) exacerbation. Methods: We performed a retrospective chart review on patients presenting to the ED with acute CHF exacerbation between January 2014–January 2016 across eight EDs in New York. We identified patients using codes from the International Classification of Diseases, 9th and 10 Revisions, or who were diagnosed with CHF in the ED. Inclusion criteria were patients ≥ 18 years of age who presented to the ED for acute CHF. Exclusion criteria included the following: end-stage renal disease related heart failure; < 18 years of age; pregnancy; palliative care; renal failure; and “do not resuscitate” directive. The primary outcome was seven-day mortality. We used mixed-effects logistic regression models to estimate C-statistics and continuous net reclassification index for events and nonevents. Results: We identified 3,320 ED visits associated with suspected CHF among 2,495 unique patients. Of the 3,320 ED visits, 94.7% patients were admitted to the hospital and 3.4% were discharged. The median age was 78.6 (interquartile range 68.01 – 86.76). There was an overall seven-day mortality of 2%, an inpatient mortality rate of 2.4%, and no mortality among the discharge group. Adding EHMRG to the risk prediction model improved the C-statistic (from 0.748 to 0.772) and led to a higher degree of reclassification for both events and nonevents. Conclusion: The EHMRG can be used as a valuable and effective screening tool in the US while considering disposition decision for patients with acute CHF exacerbation. Emergency medical services transport and metolazone use is much higher in the US population as compared to the Canadian population. We observed minimal to no short-term mortality among discharged CHF patients from the ED. |
| Databáze: | OpenAIRE |
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