External Validation of the MEESSI Acute Heart Failure Risk Score

• DOI: 10.7326/m18-1967
• Publication Date: 2019-01-28T23:48:31Z
• Authors: Desiree Wussler; Nikola Kozhuharov; Zaid Sabti; Joan Walter; Ivo Strebel; Letizia Scholl; Oscar Miró; Xavier Rossello; Francisco Javier ...; Stuart J. Pocock; Albina Nowak; Patrick Badertscher; Raphael Twerenbold; Karin Wildi; Christian Puelacher; Jeanne du Fay de ...; Samyut Shrestha; Olivia Strauch; Dayana Flores; Thomas Nestelberger; Jasper Boeddinghaus; Carmela Schumacher; Assen Goudev; Otmar Pfister; Tobias Breidthardt; Christian Mueller
• Keywords: Concordance

Background: The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score was developed to predict 30-day mortality in presenting acute heart failure (AHF) emergency departments (EDs) Spain. Whether it performs well other countries is unknown. Objective: To externally validate another country. Design: Prospective cohort study. (ClinicalTrials.gov: NCT01831115). Setting: Multicenter recruitment dyspneic ED. Participants: external validation included 1572 AHF. Measurements: Calculation using an established model containing 12 independent factors. Results: Among adjudicated AHF, 1247 had complete data that allowed calculation score. Of these, 102 (8.2%) died within 30 days. predicted excellent discrimination (c-statistic, 0.80). Assessment cumulative showed a steep gradient over 6 predefined groups (0 lowest-risk group vs. 35 [28.5%] highest-risk group). Risk overestimated high-risk groups, resulting Hosmer–Lemeshow P value 0.022. However, after adjustment intercept, good concordance between risks and observed outcomes (P = 0.23). Findings were confirmed sensitivity analyses used multiple imputation for missing values overall patients. Limitations: External done reduced model. are specific AHF who present ED clinically stable enough provide informed consent. Performance terminal kidney receiving long-term dialysis cannot be commented on. Conclusion: discrimination. Recalibration may needed when introduced new populations. Primary Funding Source: European Union, Swiss National Science Foundation, Heart Cardiovascular Research Foundation Basel, University Hospital Basel.