Highlights
- •Patients with acute HF are frequently hospitalized when they present to the ED.
- •EHMRG estimates 7-day mortality for patients with acute HF specifically in the ED.
- •EHMRG stratifies patients into risk groups to augment clinical decisions.
- •Lower risk patients with acute HF may be considered for discharge or care in EDOUs.
Abstract
Background
Heart Failure (HF) is a primary diagnosis for hospital admission from the Emergency
Department (ED), although not all patients require hospitalization. The Emergency
Heart Failure Mortality Risk Grade (EHMRG) estimates 7-day mortality in patients with
acute HF in ED settings, but further validation is needed in the United States (US).
Objectives
To validate EHMRG scores by risk-stratifying patients with acute HF in a large tertiary
healthcare center in the US and analyze outcome measures to determine if EHMRG risk
scores safely identify low-risk groups that may be discharged or managed in ED observation
units (EDOUs).
Methods
A retrospective cohort analysis of 304 patients with acute HF presenting to an ED
at a large, tertiary healthcare center was completed. EHMRG scores were calculated
to stratify patients according to published thresholds. Mortality and major adverse
cardiac event (MACE) rates were analyzed.
Results
No deaths occurred in very low and low-risk EHMRG groups at 7 days post discharge.
30-day mortality was significantly less in the lower risk groups (3.1%) when compared
to all other patients (11.1%). MACE rates at 30 days in the very low risk group (15%)
were significantly less when compared to all other patients (31.3%). Hospitalizations
occurred in 23.4% of patients in lower risk groups.
Conclusions
ED risk stratification with EHMRG differentiates high-risk patients requiring hospitalization
from lower risk patients who can be safely managed in alternative settings with good
outcomes. Data supports improved pathways for patients with acute HF during a time
of high hospital volumes.
Keywords
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Article info
Publication history
Published online: August 22, 2022
Accepted:
August 8,
2022
Received in revised form:
July 21,
2022
Received:
February 14,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
