Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
CJEM. 2023 Sep;25(9):752-760. doi: 10.1007/s43678-023-00555-6. Epub 2023 Aug 3.
Acute heart failure is a serious condition commonly seen in the emergency department (ED). The HEARTRISK6 Scale has been recently developed to identify the risk of poor outcomes but has not been tested. We sought to describe the management and outcomes of ED patients with acute heart failure and to evaluate the potential impact of the HEARTRISK6 Scale.
We conducted a health records review of 300 consecutive acute heart failure patients presenting to two tertiary care EDs. Two evaluators abstracted clinical variables, ED management and treatment details, and patient outcomes using the electronic health records platform (EPIC) and attending physicians verified the data. The primary outcome measure was a short-term serious outcome, as shown in Results. In addition, the HEARTRISK6 score was calculated retrospectively.
We included 300 patients with mean age of 78.5 years, 51.0% male, 56.3% arrival by ambulance, and 67.0% admitted to hospital. 25.3% experienced a short-term serious outcome 1) after admission (N = 201): non-invasive ventilation 14.9%, intubation 1.5%, major cardiac procedure 5.0%, myocardial infarction 2.0%, death 8.5%; 2) after ED discharge (N = 99): return to ED 21.2%, death 4.0%. Those initially admitted experienced a much higher proportion of serious outcomes compared to those discharged (29.9% vs. 16.2%). A HEARTRISK6 Scale cut-point score of ≥ 1 would have had a sensitivity of 91.0%, specificity 24.5%, and negative likelihood ratio 0.37 for short-term serious outcomes and suggested hospital admission for 80.7% of cases.
There was a large range of severity of illness of acute heart failure patients and a wide variety of treatments were administered in the ED. Both admitted and discharged patients experienced a high proportion of poor outcomes. The HEARTRISK6 Scale showed a high sensitivity for short-term serious outcomes but with the potential to increase hospital admissions. Further validation of the HEARTRISK6 Scale is required before routine clinical use.
急性心力衰竭是急诊科常见的严重病症。最近开发了 HEARTRISK6 量表来识别不良预后的风险，但尚未进行测试。我们旨在描述急诊科急性心力衰竭患者的管理和结局，并评估 HEARTRISK6 量表的潜在影响。
我们对两家三级护理急诊科的 300 例连续急性心力衰竭患者进行了病历回顾。两名评估员使用电子病历平台（EPIC）提取临床变量、急诊科管理和治疗细节以及患者结局，主治医生对数据进行了验证。主要结局指标为短期严重结局，结果中有所展示。此外，还回顾性计算了 HEARTRISK6 评分。
我们纳入了 300 例平均年龄为 78.5 岁的患者，其中 51.0%为男性，56.3%由救护车送达，67.0%入院。25.3%在入院后 1）经历了短期严重结局（N=201）：无创通气 14.9%，插管 1.5%，主要心脏手术 5.0%，心肌梗死 2.0%，死亡 8.5%；2）在急诊科出院后（N=99）：返回急诊科 21.2%，死亡 4.0%。与出院患者相比，最初入院的患者发生严重结局的比例要高得多（29.9%比 16.2%）。HEARTRISK6 量表切点评分≥1 时对短期严重结局的敏感性为 91.0%，特异性为 24.5%，阴性似然比为 0.37，建议 80.7%的病例住院。
急性心力衰竭患者的病情严重程度差异很大，急诊科给予了多种治疗方法。入院和出院患者都有很高比例的不良结局。HEARTRISK6 量表对短期严重结局具有很高的敏感性，但可能会增加住院人数。在常规临床使用之前，需要进一步验证 HEARTRISK6 量表。
