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Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure

Acute heart failure (AHF) is a cardiac emergency with an increasing incidence, especially among elderly patients. The Emergency Heart failure Mortality Risk Grade (EHMRG) has been validated to assess the 7-days AHF mortality risk, suggesting the management of patients admitted to an emergency depart...

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Autores principales: Falsetti, Lorenzo, Zaccone, Vincenzo, Guerrieri, Emanuele, Perrotta, Giulio, Diblasi, Ilaria, Giuliani, Luca, Palma, Linda Elena Gialluca, Viticchi, Giovanna, Fioranelli, Agnese, Moroncini, Gianluca, Pansoni, Adolfo, Luccarini, Marinella, Martino, Marianna, Scalpelli, Caterina, Burattini, Maurizio, Tarquinio, Nicola
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181787/
https://www.ncbi.nlm.nih.gov/pubmed/35683368
http://dx.doi.org/10.3390/jcm11112982
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author Falsetti, Lorenzo
Zaccone, Vincenzo
Guerrieri, Emanuele
Perrotta, Giulio
Diblasi, Ilaria
Giuliani, Luca
Palma, Linda Elena Gialluca
Viticchi, Giovanna
Fioranelli, Agnese
Moroncini, Gianluca
Pansoni, Adolfo
Luccarini, Marinella
Martino, Marianna
Scalpelli, Caterina
Burattini, Maurizio
Tarquinio, Nicola
author_facet Falsetti, Lorenzo
Zaccone, Vincenzo
Guerrieri, Emanuele
Perrotta, Giulio
Diblasi, Ilaria
Giuliani, Luca
Palma, Linda Elena Gialluca
Viticchi, Giovanna
Fioranelli, Agnese
Moroncini, Gianluca
Pansoni, Adolfo
Luccarini, Marinella
Martino, Marianna
Scalpelli, Caterina
Burattini, Maurizio
Tarquinio, Nicola
author_sort Falsetti, Lorenzo
collection PubMed
description Acute heart failure (AHF) is a cardiac emergency with an increasing incidence, especially among elderly patients. The Emergency Heart failure Mortality Risk Grade (EHMRG) has been validated to assess the 7-days AHF mortality risk, suggesting the management of patients admitted to an emergency department (ED). EHMRG has never been implemented in Italian ED nor among elderly patients. We aimed to assess EHMRG score accuracy in predicting in-hospital death in a retrospective cohort of elderly subjects admitted for AHF from the ED to an Internal Medicine Department. We enrolled, in a 24-months timeframe, all the patients admitted to an Internal Medicine Department from ED for AHF. We calculated the EHMRG score, subdividing patients into six categories, and assessing in-hospital mortality and length of stay. We evaluated EHMRG accuracy with ROC curve analysis and survival with Kaplan–Meier and Cox models. We collected 439 subjects, with 45 in-hospital deaths (10.3%), observing a significant increase of in-hospital death along with EHMRG class, from 0% (class 1) to 7.7% (class 5b; p < 0.0001). EHMRG was fairly accurate in the whole cohort (AUC: 0.75; 95%CI: 0.68–0.83; p < 0.0001), with the best cutoff observed at >103 (Se: 71.1%; Sp: 72.8%; LR+: 2.62; LR-: 0.40; PPV: 23.0%; NPV: 95.7%), but performed better considering the events in the first seven days of admission (AUC: 0.83; 95%; CI: 0.75–0.91; p < 0.0001). In light of our observations, EHMRG can be useful also for the Italian emergency system to predict the risk of short-term mortality for AHF among elderly patients. EHMRG performance was better in the first seven days but remained acceptable when considering the whole period of hospitalization.
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spelling pubmed-91817872022-06-10 Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure Falsetti, Lorenzo Zaccone, Vincenzo Guerrieri, Emanuele Perrotta, Giulio Diblasi, Ilaria Giuliani, Luca Palma, Linda Elena Gialluca Viticchi, Giovanna Fioranelli, Agnese Moroncini, Gianluca Pansoni, Adolfo Luccarini, Marinella Martino, Marianna Scalpelli, Caterina Burattini, Maurizio Tarquinio, Nicola J Clin Med Article Acute heart failure (AHF) is a cardiac emergency with an increasing incidence, especially among elderly patients. The Emergency Heart failure Mortality Risk Grade (EHMRG) has been validated to assess the 7-days AHF mortality risk, suggesting the management of patients admitted to an emergency department (ED). EHMRG has never been implemented in Italian ED nor among elderly patients. We aimed to assess EHMRG score accuracy in predicting in-hospital death in a retrospective cohort of elderly subjects admitted for AHF from the ED to an Internal Medicine Department. We enrolled, in a 24-months timeframe, all the patients admitted to an Internal Medicine Department from ED for AHF. We calculated the EHMRG score, subdividing patients into six categories, and assessing in-hospital mortality and length of stay. We evaluated EHMRG accuracy with ROC curve analysis and survival with Kaplan–Meier and Cox models. We collected 439 subjects, with 45 in-hospital deaths (10.3%), observing a significant increase of in-hospital death along with EHMRG class, from 0% (class 1) to 7.7% (class 5b; p < 0.0001). EHMRG was fairly accurate in the whole cohort (AUC: 0.75; 95%CI: 0.68–0.83; p < 0.0001), with the best cutoff observed at >103 (Se: 71.1%; Sp: 72.8%; LR+: 2.62; LR-: 0.40; PPV: 23.0%; NPV: 95.7%), but performed better considering the events in the first seven days of admission (AUC: 0.83; 95%; CI: 0.75–0.91; p < 0.0001). In light of our observations, EHMRG can be useful also for the Italian emergency system to predict the risk of short-term mortality for AHF among elderly patients. EHMRG performance was better in the first seven days but remained acceptable when considering the whole period of hospitalization. MDPI 2022-05-25 /pmc/articles/PMC9181787/ /pubmed/35683368 http://dx.doi.org/10.3390/jcm11112982 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Falsetti, Lorenzo
Zaccone, Vincenzo
Guerrieri, Emanuele
Perrotta, Giulio
Diblasi, Ilaria
Giuliani, Luca
Palma, Linda Elena Gialluca
Viticchi, Giovanna
Fioranelli, Agnese
Moroncini, Gianluca
Pansoni, Adolfo
Luccarini, Marinella
Martino, Marianna
Scalpelli, Caterina
Burattini, Maurizio
Tarquinio, Nicola
Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure
title Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure
title_full Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure
title_fullStr Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure
title_full_unstemmed Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure
title_short Implementation of EHMRG Risk Model in an Italian Population of Elderly Patients with Acute Heart Failure
title_sort implementation of ehmrg risk model in an italian population of elderly patients with acute heart failure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181787/
https://www.ncbi.nlm.nih.gov/pubmed/35683368
http://dx.doi.org/10.3390/jcm11112982
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