title: Predicting short-term mortality in patients with acute exacerbation of chronic heart failure: The EAHFE-3D scale.
abstract: OBJECTIVE
  Prognostic scales are needed in acute exacerbation of chronic heart failure to detect early mortality. The objective of this study is to create a prognostic scale (scale EAHFE-3D) to stratify the risk of death the very short term.
  
  
  METHODS
  We used the EAHFE database, a multipurpose, multicenter registry with prospective follow-up currently including 6,597 patients with acute heart failure attended at 34 Spanish Emergency Departments from 2007 to 2014. The following variables were collected: demographic, personal history, data of acute episode and 3-day mortality. The derivation cohort included patients recruited during 2009 and 2011 EAHFE registry spots (n=3,640). The classifying variable was all-cause 3-day mortality. A prognostic scale (3D-EAHFE scale) with the results of the multivariate analysis based on the weight of the OR was created. The 3D-EAHFE scale was validated using the cohort of patients included in 2014 spot (n=2,957).
  
  
  RESULTS
  A total of 3,640 patients were used in the derivation cohort and 102 (2.8%) died at 3 days. The final scale contained the following variables (maximum 165 points): age≥75 years (30 points), baseline NYHA III-IV (15 points), systolic blood pressure<110mmHg (20 points), room-air oxygen saturation<90% (30 points), hyponatremia (20 points), inotropic or vasopressor treatment (30 points) and need for noninvasive mechanical ventilation (20 points); with a ROC curve of 0.80 (95% CI 0.76-0.84; P<.001). The validation cohort included 2,957 patients (66 died at 3 days, 2.2%), and the scale obtained a ROC curve of 0.76 (95% CI 0.70-0.82; P<.001). The risk groups consisted of very low risk (0-20 points), low risk (21-40 points), intermediate risk (41-60 points), high risk (61-80 points) and very high risk (>80 points), with a mortality (derivation/validation cohorts) of 0/0.5, 0.8/1.0, 2.9/2.8, 5.5/5.8 and 12.7/22.4%, respectively.
  
  
  CONCLUSIONS
  EAHFE-3D scale may help to predict the very short term prognosis of patients with acute heart failure in 5 risk groups.
authors.affiliation: Servicio de Urgencias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. Electronic address: jjacob@bellvitgehospital.cat.
authors.forename: J
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Grupo de investigación Urgencias: Procesos y Patologías, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Área de Urgencias, Hospital Clínic, Barcelona, España.
authors.forename: Ò
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
authors.forename: P
authors.initials: P
authors.lastname: Herrero
authors.affiliation: Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
authors.forename: F J
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.affiliation: Grupo de investigación Urgencias: Procesos y Patologías, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Área de Urgencias, Hospital Clínic, Barcelona, España.
authors.forename: V
authors.initials: V
authors.lastname: Gil
authors.affiliation: Servicio de Urgencias, Consorci Sanitari de Terrassa, Terrassa, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Tost
authors.affiliation: Servicio de Urgencias, Hospital del Mar, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Aguirre
authors.affiliation: Grupo de investigación Urgencias: Procesos y Patologías, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Área de Urgencias, Hospital Clínic, Barcelona, España.
authors.forename: R
authors.initials: R
authors.lastname: Escoda
authors.affiliation: Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Alquézar
authors.affiliation: Servicio de Urgencias, Hospital Gregorio Marañón, Madrid, España.
authors.forename: J A
authors.initials: JA
authors.lastname: Andueza
authors.affiliation: Unidad de Corta Estancia y Unidad de Hospitalización a Domicilio, Servicio de Urgencias, Hospital General de Alicante, Alicante, España.
authors.forename: P
authors.initials: P
authors.lastname: Llorens
mesh_terms: D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment
keywords: Acute heart failure; Early mortality; Emergency Department; Escala pronóstica; Insuficiencia cardiaca crónica agudizada; Mortalidad precoz; Prognostic scale; Servicio de Urgencias