SPC365

Real-World Applicability of the Emergency Heart Failure Mortality Risk Grade in Reducing Hospitalization

Session: Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker: Mariana Passos

Congress: CPC 2024
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 11. Acute Heart Failure
Subtheme: 11.6 Acute Heart Failure - Clinical
Session Type: Cartazes
FP Number: ---
Authors: Mariana Passos; Filipa Gerardo; Carolina Mateus; Joana Lima Lopes; Inês Miranda; Mara Sarmento; Ana Oliveira Soares; David Roque
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction:&nbsp;</span></span></strong></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Hospitalizations for heart failure (HF) are common and impose a heavy burden on healthcare resources. Efforts to decrease potentially avoidable hospital admissions are crucial. The Emergency Heart failure Mortality Risk Grade (EHMRG) initially design to predict mortality within 7 days of presentation, allows risk assessment for acute HF in the emergency department (ED) aiding the stratification of care levels (admission versus early discharge).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Objectives:</span></span></strong> </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">To assess the ability of the EHMRG to identify low risk patients and reduce the number of hospital admissions for decompensated HF.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods:</span></span></strong> </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">We conducted a single-center study on 253 patients who attended the ED for decompensated HF between March 2021 and September 2023. Patients with history of chronic dialysis and without available information about at least one of the EHFMRG variables were excluded. The EHMRG was calculated retrospectively, and according to it, patients were stratified in risk groups.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results:</span></span></strong> </span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">A total of 179 patients were included (age 68 [IQR 57-76] years, 34% female). Based on clinical judgement, 167 (93.3%) patients were hospitalized. Applying the EHMRG, patients were stratified in 5 risk groups: 43.6% (n=78) very high; 25.7% (n=46) high; 14% (n=25) intermediate; 12.3% (n=22) low; 4.5% (n=8) very low. According to the EHMRG, discharge is considered safe in very low and low risk groups; therefore 16.8% (n= 30) could have been discharged. &nbsp;In the intermediate group, we decided to assesse whether there were any criteria for hospitalization in the coronary care unit or intensive care, and exclude those with an acute coronary syndrome (n=8), requiring oxygen supplementation (n=6) and hemodynamically unstable (n=1). Therefore, if decision-making had been based on EHMRG, only 139 (77.6%) patients would have been hospitalized (p=0.028).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">There were no deaths in the 30 days post-discharge, however 14.5% (n=26) patients were readmitted for HF worsening.&nbsp;</span></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">In 34 patients (18.9%) hospitalization was deemed necessary based on clinical judgement, while the EHMRG indicated that discharge would have been safe. However, of those 3 (1.7%) were readmitted within 30 days after discharge, all of them were classified as intermediate risk based in the additional referred criteria. In contrast, discharge was considered safe based on clinical judgement in 6 patients (3.4%), while the EHMRG indicated that hospitalization would have been advised. &nbsp;Of those 1 (0.6%), that was classified as high risk, was readmitted for HF worsening.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusion:&nbsp;</span></span></strong></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri Light&quot;,sans-serif">The EHMRG accurately differentiates between high and low-risk acute HF patients visiting the ED. In our population, according to the EHMRG, the number of admissions for HF can be reduced by 16.8%, reducing costs and potentially prevent iatrogenic complications, ideally with an cardiology appointment scheduled.</span></span></span></span></p>