{"id":5166,"date":"2012-06-05T00:00:00","date_gmt":"2012-06-05T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/prediction-of-heart-failure-mortality-in-emergent-care-a-cohort-study\/"},"modified":"2023-06-14T20:01:07","modified_gmt":"2023-06-15T00:01:07","slug":"prediction-of-heart-failure-mortality-in-emergent-care-a-cohort-study","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/prediction-of-heart-failure-mortality-in-emergent-care-a-cohort-study\/","title":{"rendered":"Prediction of heart failure mortality in emergent care: a cohort study"},"content":{"rendered":"

Background<\/strong> — Heart failure contributes to millions of emergency department (ED) visits, but hospitalization-versus-discharge decisions are often not accompanied by prognostic risk quantification.<\/p>\n

Objective<\/strong> — To derive and validate a model for acute heart failure mortality applicable in the ED.<\/p>\n

Design<\/strong> — Clinical data abstraction with development of a broadly applicable multivariate risk index for 7-day death using initial vital signs, clinical and presentation features, and readily available laboratory tests.<\/p>\n

Setting<\/strong> — Multicenter study of 86 hospitals in Ontario, Canada.<\/p>\n

Patients<\/strong> — Population-based random sample of 12,591 patients presenting to the ED from 2004 to 2007.<\/p>\n

Measurements<\/strong> — Death within 7 days of presentation.<\/p>\n

Results<\/strong> — In the derivation cohort (n = 7433; mean age, 75.4 years [SD, 11.4]; 51.5% men), mortality risk increased with higher triage heart rate (adjusted odds ratio [OR], 1.15 [95% CI, 1.03 to 1.30] per 10 beats\/min) and creatinine concentration (OR, 1.35 [CI, 1.14 to 1.60] per 1 mg\/dL [88.4 μmol\/L]), lower triage systolic blood pressure (OR, 1.52 [CI, 1.31 to 1.77] per 20 mm Hg) and initial oxygen saturation (OR, 1.16 [CI, 1.01 to 1.33] per 5%). Non-normal serum troponin levels (OR, 2.75 [CI, 1.86 to 4.07]) were associated with increased mortality risk. Areas under the receiver-operating characteristic curves of the multivariate model were 0.805 for the derivation data set (bootstrap-corrected, 0.811) and 0.826 for validation data set (n = 5158; mean age, 75.7 years [SD, 11.4]; 51.6% men). In the derivation cohort, a multivariate index score stratified 7-day mortality with rates of 0.3%, 0.3%, 0.7%, and 1.9% in quintiles 1 to 4, respectively. Mortality rates in the 2 highest risk groups were 3.5% and 8.2% in deciles 9 and 10, respectively.<\/p>\n

Limitation<\/strong> — Left ventricular ejection fraction was not included in the model.<\/p>\n

Conclusion<\/strong> — A multivariate index composed of routinely collected variables stratified mortality risk with high discrimination in a broad group of patients with acute heart failure presenting to the ED.<\/p>\n","protected":false},"excerpt":{"rendered":"

Background — Heart failure contributes to millions of emergency department (ED) visits, but hospitalization-versus-discharge decisions are often not accompanied by prognostic risk quantification. Objective — To derive and validate a model for acute heart failure mortality applicable in the ED. Design — Clinical data abstraction with development of a broadly applicable multivariate risk index for […]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[24,40],"migration-helper-qa-sample-set":[],"class_list":["post-5166","journal_article","type-journal_article","status-publish","hentry","topic-acute-and-emergency-services","topic-cardiovascular-disease"],"acf":{"citation":"Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, Newton GE, Lee JS, Tu JV. Ann Intern Med<\/em>. 2012; 56(11):767-75. Epub Jun 5 2012.","source_url":"","ices_scientist":[1290,1385,1372,1368],"site":[6733],"research_program":[6742,6740],"news_release":[7499],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"84F469BA-3A30-4280-8B23-C357481BF637","sitecore_item_name":"Prediction-of-heart-failure-mortality-in-emergent-care-a-cohort-study","sitecore_field_values":"{\n \"Title\": \"Prediction of heart failure mortality in emergent care: a cohort study\",\n \"Short title\": \"Prediction of heart failure mortality\",\n \"Citation\": \"

Lee DS, Stitt A, Austin PC, Stukel TA, Schull MJ, Chong A, Newton GE, Lee JS, Tu JV. Ann Intern Med<\/em>. 2012; 56(11):767-75. Epub Jun 5 2012.<\/p>\",\n \"Abstract\": \"

Background<\/strong> — Heart failure contributes to millions of emergency department (ED) visits, but hospitalization-versus-discharge decisions are often not accompanied by prognostic risk quantification.<\/p>n

Objective<\/strong> — To derive and validate a model for acute heart failure mortality applicable in the ED.<\/p>n

Design<\/strong> — Clinical data abstraction with development of a broadly applicable multivariate risk index for 7-day death using initial vital signs, clinical and presentation features, and readily available laboratory tests.<\/p>n

Setting<\/strong> — Multicenter study of 86 hospitals in Ontario, Canada.<\/p>n

Patients<\/strong> — Population-based random sample of 12,591 patients presenting to the ED from 2004 to 2007.<\/p>n

Measurements<\/strong> — Death within 7 days of presentation.<\/p>n

Results<\/strong> — In the derivation cohort (n = 7433; mean age, 75.4 years [SD, 11.4]; 51.5% men), mortality risk increased with higher triage heart rate (adjusted odds ratio [OR], 1.15 [95% CI, 1.03 to 1.30] per 10 beats\/min) and creatinine concentration (OR, 1.35 [CI, 1.14 to 1.60] per 1 mg\/dL [88.4 μmol\/L]), lower triage systolic blood pressure (OR, 1.52 [CI, 1.31 to 1.77] per 20 mm Hg) and initial oxygen saturation (OR, 1.16 [CI, 1.01 to 1.33] per 5%). Non-normal serum troponin levels (OR, 2.75 [CI, 1.86 to 4.07]) were associated with increased mortality risk. Areas under the receiver-operating characteristic curves of the multivariate model were 0.805 for the derivation data set (bootstrap-corrected, 0.811) and 0.826 for validation data set (n = 5158; mean age, 75.7 years [SD, 11.4]; 51.6% men). In the derivation cohort, a multivariate index score stratified 7-day mortality with rates of 0.3%, 0.3%, 0.7%, and 1.9% in quintiles 1 to 4, respectively. Mortality rates in the 2 highest risk groups were 3.5% and 8.2% in deciles 9 and 10, respectively.<\/p>n

Limitation<\/strong> — Left ventricular ejection fraction was not included in the model.<\/p>n

Conclusion<\/strong> — A multivariate index composed of routinely collected variables stratified mortality risk with high discrimination in a broad group of patients with acute heart failure presenting to the ED.<\/p>\",\n \"Keywords\": \"{A343F477-C16C-4AAB-B0F6-3196D049F653}|{92E2791D-5DAB-4244-8A85-434D524D9A12}\",\n \"Related Products\": \"

News Release<\/h2>rn

Emergency department algorithm may predict risk of death for heart failure patients<\/a><\/h3>\",\n \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}|{46DF28D2-EDE8-4DF2-8CC0-87CEF464E435}\",\n \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n \"ICES Scientists\": \"{CEEE13AD-C7DE-455F-ACF8-AAD7D27BB178}|{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}|{A0978F87-1C10-4E62-A833-89616146CA59}|{3504EE2C-F0D3-4BEC-8704-14D8CEC924BB}|{956599EC-5699-41D3-9375-E0B6C25B12D5}\",\n \"Posted Date\": \"20120605T000000\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2012\/January\/Prediction-of-heart-failure-mortality-in-emergent-care-a-cohort-study"},"yoast_head":"\nICES | Prediction of heart failure mortality in emergent care: a cohort study<\/title>\n<meta name=\"description\" content=\"Background — Heart failure contributes to millions of emergency department (ED) visits, but hospitalization-versus-discharge decisions are often\" \/>\n<meta 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