Gil et al used the Emergency Heart Failure Mortality Risk Grade Score to evaluate heart failure patients in the Emergency Department (ED). This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple hospitals in Spain and Canada.
Patient selection: heart failure being seen in the emergency department (ED)
Outcome: 7-day mortality rate
Parameters:
(1) age in years
(2) transported to ED by Emergency Medical Services (EMS)
(3) active cancer
(4) therapy with metolazone
(5) systolic blood pressure in mm Hg
(6) heart rate in beats per minute
(7) oxygen saturation in percent
(8) serum creatinine in mg/dL
(9) serum potassium in mmol/L
(10) elevation in serum troponin
|
Parameter
|
Points
|
|
age in years
|
2 * (age)
|
|
systolic blood pressure
|
(-1) * (systolic blood pressure)
|
|
heart rate
|
(heart rate)
|
|
oxygen saturation
|
(-2) * (oxygen saturation)
|
|
serum creatinine
|
20 * (serum creatinine)
|
|
Parameter
|
Finding
|
Points
|
|
transport by EMS
|
no
|
0
|
|
|
yes
|
60
|
|
active cancer
|
no
|
0
|
|
|
yes
|
45
|
|
therapy with metolazone
|
no
|
0
|
|
|
yes
|
60
|
|
serum troponin
|
normal
|
0
|
|
|
elevated
|
60
|
|
serum potassium
|
<= 3.9 mmol/L
|
5
|
|
|
3.91 to 4.59
|
0
|
|
|
>= 4.6 mmol/L
|
30
|
total score =
= SUM(points for all 10 parameters) +12
where:
• The 12 points is an adjustment score to allow a median score = 0.
Interpretation:
• minimum score: -123.6
• maximum score: 261.9
• mean score: 54.6
• The higher the score the greater the mortality.
|
Score
|
Quintile
|
7-Day Mortality
|
|
1
|
<= 5.55
|
0.8%
|
|
2
|
5.56 to 33.56
|
2.3%
|
|
3
|
33.57 to 70.95
|
2.8%
|
|
4
|
70.96 to 113.25
|
5.5%
|
|
5a
|
113.26 to 142.69
|
8.7%
|
|
5b
|
>= 143.70
|
16%
|
Performance:
• The area under the ROC curve is 0.74.
