title: An early warning scoring system for the prevention of acute heart failure.
abstract: BACKGROUND
  Early prediction and identification of the onset of acute heart failure (AHF) in high-risk patients are of great significance for preemptive treatment and a better prognosis. We sought to find a scoring system to predict the onset of AHF in patients in the acute heart failure unit (AHFU).
  
  
  METHODS
  Data for 433 patients at of AHF in the AHFU were analyzed. We recorded sex, age, history of coronary artery disease, hypertension, diabetes, and primary percutaneous coronary intervention. We also reviewed temperature, pulse, SpO₂, respiratory rate, urine volume, and emotional state every hour before the onset of AHF. All admission and follow-up data were retrieved from hospital charts. Factors were analyzed using a binary logistic regression model to create the SUPER (SpO₂, urine volume, pulse, emotional state, and respiratory rate) scoring model. We divided the scoring system into four levels: low-, intermediate-, high-, and extremely high-risk. Patients fitting the four risk levels were followed up for 6 to 24 months.
  
  
  RESULTS
  SpO₂, hourly urine volume, pulse, emotional state and respiratory rates were associated with an independent increased risk for the onset of AHF. The SUPER score for the patients in the AHFU predicted the onset of AHF 3.90 ± 1.94 h (1-17 h) earlier. The areas under the ROC curve for the SUPER score and the modified early warning score were 0.811 and 0.662 (p<0.05), indicating that the SUPER score provided a better warning of the AHF. A low-, intermediate-, high-, and very high-risk SUPER predicted the likelihood of AHF at 17.3%, 61.3%, 84.4%, and 94.0%, respectively. The differences in mortality rates between the four levels were statistically significant (p<0.05).
  
  
  CONCLUSIONS
  In patients at high risk of AHF, the SUPER scoring system could predict the onset of AHF 2 to 6h earlier. Preemptive treatment according to the SUPER score may prevent or delay AHF occurrence to improve quality of life and reduce mortality.
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Medicine School of Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Yuan
authors: Y
authors: Bian
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Feng
authors: F
authors: Xu
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Rui-juan
authors: RJ
authors: Lv
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Jia-li
authors: JL
authors: Wang
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Li-jun
authors: LJ
authors: Cao
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Li
authors: L
authors: Xue
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Medicine School of Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China.
authors: Wen
authors: W
authors: Zheng
authors: Medicine School of Shandong University, Jinan, China.
authors: Yan-xiang
authors: YX
authors: Qiao
authors: Medicine School of Shandong University, Jinan, China.
authors: Xian-liang
authors: XL
authors: Yan
authors: Medicine School of Shandong University, Jinan, China.
authors: Zhen-fang
authors: ZF
authors: Liu
authors: Department of Cardiology, Qilu Hospital, Shandong University, Jinan, China.
authors: Yun
authors: Y
authors: Zhang
authors: Department of Emergency, Qilu Hospital, Shandong University, Jinan, China; Chest Pain Center, Qilu Hospital, Shandong University, Jinan, China. Electronic address: chen919805@126.com.
authors: Yu-guo
authors: YG
authors: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
keywords: Acute heart failure; Acute heart failure unit; Early warning; Preventive medicine