"We developed a risk score consisting of a set of simple questions and routinely available tests which we call the Emergency Heart Failure Mortality Risk Grade," Dr. Lee told the Congress.
"It is a score that can be calculated in any emergency department and could be employed anywhere around the world because it does not require any sophisticated tests," he said.
This simple clinical risk model can predict, with high accuracy, mortality among HF patients who present to the ED and may guide admission versus discharge decision-making, he said.
Dr. Lee and his team examined 12,591 patients with acute heart failure who presented to the ED between 2004 and 2007 in Ontario.
They developed a clinical risk score that would predict the chances of a patient dying within seven days after discharge from the ED, using readily available factors.
The factors that predicted greater risk of dying within seven days included greater acuity (i.e., need for emergency medical services), even slightly elevated troponin levels, increased serum creatinine, and either high or low serum potassium. If patients developed heart failure while using Metolazone a drug that sicker heart failure patients have to use they were also at higher risk.
Systolic blood pressure, heart rate, and oxygen saturation were also important predictors of mortality.
When all of these risk factors were combined, Dr. Lee and his team found that patients in the highest risk group had a seven-day mortality rate of about eight per cent, meaning that for every 12 patients in the highest risk group, one of them would die within seven days.
Patients in the lowest risk group on the contrary had a mortality rate of about 0.3 per cent, meaning that for every 350 patients who were discharged, there would be only one death.
"This is an ongoing area of study. We haven't solved the problem yet, but it's a big st
|Contact: Amanda Bates|
Heart and Stroke Foundation of Canada