title: Creation and validation of the acute heart failure risk score: AHFRS.
abstract: Our aims were to create and validate a clinical decision rule to assess severity in acute heart failure. We conducted a prospective cohort study of patients with symptoms of acute heart failure who attended the emergency departments (EDs) of three hospitals between April 2011 and April 2013. The following data were collected on arrival to or during the stay in the ED: baseline severity of symptoms; presence of decompensated comorbidities; number of hospital admissions/visits to EDs for acute heart failure during the previous 24 months; triggers of the exacerbation; clinical signs and symptoms; results of ancillary tests requested in the ED; treatments prescribed; and response to the initial treatment in the ED. The main outcome was poor course during the acute phase, in-hospital for admitted patients and during the first week following the ED visit for discharged patients, this being a composite endpoint that included death, admission to an intensive care unit, need for invasive mechanical ventilation, cardiac arrest and use of non-invasive mechanical ventilation. Multivariate logistic regression models were developed. Predictors of poor course in acute heart failure were oedema on chest radiography, visits to the ED and/or admissions in the previous two years, and levels of glycemia and blood urea nitrogen (areas under the curve of 0.83 in the derivation sample, and 0.82 in the validation sample). Four clinical predictors available in the ED can be used to create a simple score to predict poor course in acute heart failure.Clinical Trials.gov ID: NCT02437058.
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Barrio Labeaga s/n, 48960, Galdakao, Vizcaya, Spain. susana.garciagutierrez@osakidetza.net.
authors.forename: Susana
authors.identifier: http://orcid.org/0000-0002-8474-2479
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Barrio Labeaga s/n, 48960, Galdakao, Vizcaya, Spain.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Quintana
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo [Osakidetza], Red de Investigación en Servicios de Salud en Enfermedades Crónicas [REDISSEC], Barrio Labeaga s/n, 48960, Galdakao, Vizcaya, Spain.
authors.forename: Ane
authors.initials: A
authors.lastname: Antón-Ladislao
authors.affiliation: Servicio de Urgencias, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Gallardo
authors.affiliation: Servicio de Urgencias, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Pulido
authors.affiliation: Servicio de Cardiología, Hospital Donostia, Donostia, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Rilo
authors.affiliation: Servicio de Medicina Interna, Hospital Donostia, Donostia, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Zubillaga
authors.affiliation: Servicio de Cardiología, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Miren
authors.initials: M
authors.lastname: Morillas
authors.affiliation: Servicio de Cardiología, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: José Juan
authors.initials: JJ
authors.lastname: Onaindia
authors.affiliation: Servicio de Cardiología, Hospital de Basurto, Bilbao, Spain.
authors.forename: Nekane
authors.initials: N
authors.lastname: Murga
authors.affiliation: Servicio de Urgencias, Hospital Donostia, Donostia, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Palenzuela
authors.affiliation: Servicio de Cardiología, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: José González
authors.initials: JG
authors.lastname: Ruiz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D063868:Patient Outcome Assessment; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000592:standards*; D013030:Spain; D054928:Validation Studies as Topic
keywords: Acute heart failure; Prognosis; Risk stratification