External Validation of the MEESSI Acute Heart Failure Risk Score: A Cohort Study

Wussler, Desiree and Kozhuharov, Nikola and Sabti, Zaid and Walter, Joan and Strebel, Ivo and Scholl, Letizia and Miró, Oscar and Rossello, Xavier and Martín-Sánchez, Francisco Javier and Pocock, Stuart J. and Nowak, Albina and Badertscher, Patrick and Twerenbold, Raphael and Wildi, Karin and Puelacher, Christian and du Fay de Lavallaz, Jeanne and Shrestha, Samyut and Strauch, Olivia and Flores, Dayana and Nestelberger, Thomas and Boeddinghaus, Jasper and Schumacher, Carmela and Goudev, Assen and Pfister, Otmar and Breidthardt, Tobias and Mueller, Christian. (2019) External Validation of the MEESSI Acute Heart Failure Risk Score: A Cohort Study. Annals of internal medicine, 170 (4). pp. 248-256.

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Official URL: https://edoc.unibas.ch/77000/

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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 patients presenting with acute heart failure (AHF) to emergency departments (EDs) in Spain. Whether it performs well in other countries is unknown.; To externally validate the MEESSI-AHF score in another country.; Prospective cohort study. (ClinicalTrials.gov: NCT01831115).; Multicenter recruitment of dyspneic patients presenting to the ED.; The external validation cohort included 1572 patients with AHF.; Calculation of the MEESSI-AHF score using an established model containing 12 independent risk factors.; Among 1572 patients with adjudicated AHF, 1247 had complete data that allowed calculation of the MEESSI-AHF score. Of these, 102 (8.2%) died within 30 days. The score predicted 30-day mortality with excellent discrimination (c-statistic, 0.80). Assessment of cumulative mortality showed a steep gradient in 30-day mortality over 6 predefined risk groups (0 patients in the lowest-risk group vs. 35 [28.5%] in the highest-risk group). Risk was overestimated in the high-risk groups, resulting in a Hosmer-Lemeshow P value of 0.022. However, after adjustment of the intercept, the model showed good concordance between predicted risks and observed outcomes (P = 0.23). Findings were confirmed in sensitivity analyses that used multiple imputation for missing values in the overall cohort of 1572 patients.; External validation was done using a reduced model. Findings are specific to patients with AHF who present to the ED and are clinically stable enough to provide informed consent. Performance in patients with terminal kidney failure who are receiving long-term dialysis cannot be commented on.; External validation of the MEESSI-AHF risk score showed excellent discrimination. Recalibration may be needed when the score is introduced to new populations.; The European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel, and University Hospital Basel.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Kozhuharov, Nikola and Müller, Christian and Wussler, Desiree
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:19 Aug 2020 12:40
Deposited On:19 Aug 2020 12:40

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