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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...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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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. |
format | Online Article Text |
id | pubmed-9181787 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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