Mayo Clinic, Department of Cardiovascular Diseases, 200 1st Street SW Rochester, MN 55905, United States; Department of Graduate Nursing, Winona State University-Rochester, 400 South Broadway SE, Rochester, MN 55904, United States.
Mayo Clinic, Department of Emergency Medicine, 200 1st Street SW Rochester, MN 55905, United States.
Heart Lung. 2023 Jan-Feb;57:31-40. doi: 10.1016/j.hrtlng.2022.08.005. Epub 2022 Aug 22.
Heart Failure (HF) is a primary diagnosis for hospital admission from the Emergency Department (ED), although not all patients require hospitalization. The Emergency Heart Failure Mortality Risk Grade (EHMRG) estimates 7-day mortality in patients with acute HF in ED settings, but further validation is needed in the United States (US).
To validate EHMRG scores by risk-stratifying patients with acute HF in a large tertiary healthcare center in the US and analyze outcome measures to determine if EHMRG risk scores safely identify low-risk groups that may be discharged or managed in ED observation units (EDOUs).
A retrospective cohort analysis of 304 patients with acute HF presenting to an ED at a large, tertiary healthcare center was completed. EHMRG scores were calculated to stratify patients according to published thresholds. Mortality and major adverse cardiac event (MACE) rates were analyzed.
No deaths occurred in very low and low-risk EHMRG groups at 7 days post discharge. 30-day mortality was significantly less in the lower risk groups (3.1%) when compared to all other patients (11.1%). MACE rates at 30 days in the very low risk group (15%) were significantly less when compared to all other patients (31.3%). Hospitalizations occurred in 23.4% of patients in lower risk groups.
ED risk stratification with EHMRG differentiates high-risk patients requiring hospitalization from lower risk patients who can be safely managed in alternative settings with good outcomes. Data supports improved pathways for patients with acute HF during a time of high hospital volumes.
心力衰竭（HF）是急诊科（ED）入院的主要诊断，尽管并非所有患者都需要住院治疗。急诊心力衰竭死亡率风险分级（EHMRG）估计了 ED 环境中急性 HF 患者的 7 天死亡率，但在美国（US）需要进一步验证。
通过对美国一家大型三级保健中心的急性 HF 患者进行风险分层，验证 EHMRG 评分，并分析结局指标，以确定 EHMRG 风险评分是否安全地识别出可能在 ED 观察单元（EDOU）出院或接受 ED 管理的低危人群。
对一家大型三级保健中心 ED 就诊的 304 例急性 HF 患者进行回顾性队列分析。计算 EHMRG 评分以根据公布的阈值对患者进行分层。分析死亡率和主要不良心脏事件（MACE）发生率。
在出院后 7 天，极低危和低危 EHMRG 组无死亡发生。与所有其他患者（11.1%）相比，较低风险组（3.1%）的 30 天死亡率显著降低。极低危组（15%）的 30 天 MACE 发生率明显低于所有其他患者（31.3%）。较低风险组的住院率为 23.4%。
ED 采用 EHMRG 进行风险分层，可区分需要住院治疗的高危患者和可在替代环境中安全管理的低危患者，这些患者的结局良好。在医院容量较高的时期，该数据支持为急性 HF 患者提供更好的治疗途径。
