急性心力衰竭(AHF)是一种常见的急诊科(ED)表现,可能有不良的结果,但通常不需要住院。几乎没有证据可以指导态度决定。
作者试图创建一个风险评分来预测AHF患者的短期严重结局(SSO)。
■我们汇集了3个前瞻性队列的数据:2个已发表的研究和1个新队列。3组前瞻性招募了在10个三级护理医院ED中需要治疗AHF的患者。主要结果是SSO,定义为死亡<30天,插管或非侵入性通气(NIV),心肌梗塞,或复发至ED<14天。逻辑回归模型评估了13个预测因子,使用基于AIC的降压程序,并引导内部验证。
■在3个队列中的2,246名患者中(N=559;1,100;587),平均年龄是77.4岁,54.5%为男性,3.1%接受静脉注射硝酸甘油,5.2%收到EDNIV,48.6%住院。共有281例(12.5%)SSO,其中70例死亡(3.1%),其中许多患者出院。最终的HEARTRISK6量表包括6个变量:心脏瓣膜病,心动过速,需要NIV,肌酐,肌钙蛋白,和失败的重新评估(步行测试)。选择HEARTRISK6总分入院阈值≥1或≥2会产生,分别,SSO的敏感性为88.3%(95%CI:83.9%-91.8%)和71.5%(95%CI:65.9%-76.7%),特异性为24.7%(95%CI:22.8%-26.7%)和50.1%(95%CI:47.9%-52.4%)。
■使用3个大型前瞻性收集的数据集,我们为ED中的AHF患者创建了一个简明而敏感的风险量表.HEARTRISK6量表的实施可能会导致更安全,更有效的处置决策。
UNASSIGNED: Acute heart failure (AHF) is a common emergency department (ED) presentation that may have poor outcomes but often does not require hospital admission. There is little evidence to guide dispositional decisions.
UNASSIGNED: The authors sought to create a risk score for predicting short-term serious outcomes (SSO) in patients with AHF.
UNASSIGNED: We pooled data from 3 prospective cohorts: 2 published studies and 1 new cohort. The 3 cohorts prospectively enrolled patients who required treatment for AHF at 10 tertiary care hospital EDs. The primary outcome was SSO, defined as death <30 days, intubation or noninvasive ventilation (NIV), myocardial infarction, or relapse to ED <14 days. The logistic regression model evaluated 13 predictors, used an AIC-based step-down procedure, and bootstrapped internal validation.
UNASSIGNED: Of the 2,246 patients in the 3 cohorts (N = 559; 1,100; 587), the mean age was 77.4 years, 54.5% were male, 3.1% received intravenous nitroglycerin, 5.2% received ED NIV, and 48.6% were admitted to the hospital. There were 281 (12.5%) SSOs including 70 deaths (3.1%) with many in discharged patients. The final HEARTRISK6 Scale included 6 variables: valvular heart disease, tachycardia, need for NIV, creatinine, troponin, and failed reassessment (walk test). Choosing HEARTRISK6 total-point admission thresholds of ≥1 or ≥2 would yield, respectively, sensitivities of 88.3% (95% CI: 83.9%-91.8%) and 71.5% (95% CI: 65.9%-76.7%) and specificities of 24.7% (95% CI: 22.8%-26.7%) and 50.1% (95% CI: 47.9%-52.4%) for SSO.
UNASSIGNED: Using 3 large prospectively collected datasets, we created a concise and sensitive risk scale for patients with AHF in the ED. Implementation of the HEARTRISK6 scale could lead to safer and more efficient disposition decisions.