Authors:

O Miro¹ , X Rossello² , V Gil¹ , H Bueno² , P Llorens³ , FJ Martin-Sanchez⁴ , J Jacob⁵ , P Herrero-Puente⁶ , R Escoda¹ , S Aguilo¹ , C Sanchez¹ , J Marco-Hernandez¹ , G Martinez¹ , V Rico¹ , SJ Pocock² , ¹Hospital Clinic de Barcelona, Emergency Department - Barcelona - Spain , ²National Centre for Cardiovascular Research (CNIC) - Madrid - Spain , ³General University Hospital of Alicante, Emergency Department - Alicante - Spain , ⁴Hospital Clinic San Carlos, Emergency Department - Madrid - Spain , ⁵University Hospital of Bellvitge, Emergency Department - Barcelona - Spain , ⁶University Hospital Central de Asturias, Emergency Department - Oviedo - Spain ,

Aims: The MEESSI (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with acute heart failure –AHF-) scale is a new tool to stratify AHF patients at the emergency department (ED) according to the 30-day mortality risk. We aimed to validate the MEESSI risk score in a new cohort of Spanish patients to assess its accuracy in stratifying patients by risk and to compare its performance in different settings.

Methods: We included consecutive patients diagnosed with AHF in 30 EDs during January and February 2016 (60 fays). The MEESSI score was calculated for each patient. The area under the curve of the receiver operating characteristic (AUC ROC) measured the discriminatory capacity to predict 30-day mortality of the MEESSI full model (13 variables) and the 7 secondary models (lacking the Barthel Index, troponin or NT-ProBNP, in any combination). Further comparisons were made between subgroups of patients from university and community hospitals, EDs with high, medium or low activity and EDs that recruited or not patients in the original MEESSI derivation cohort.

Results: We analyzed 4711 patients (university/community hospitals: 3811/900; high-/medium-/low-activity EDs: 2695/1479/537; EDs participating/not participating in the previous MEESSI derivation study: 3892/819). The distribution of patients according to the MEESSI risk categories was: 1673 (35.5%) low-risk, 2023 (42.9%) intermediate-risk, 530 (11.3%) high-risk and 485 (10.3%) very high-risk, with 30-day mortality of 2.0%, 7.8%, 17.9% and 41.4%, respectively. The AUC ROC for the full model was 0.810 (95% CI: 0.790-0.830), and ranged from 0.731 to 0.785 for the subsequent secondary models. The discriminatory capacity of the MEESSI risk score was similar among subgroups of hospital type, ED activity, and original recruiter EDs (Figure 1).

Conclusion: The MEESSI risk score successfully stratifies AHF patients at the ED according to the 30-day mortality risk, potentially helping clinicians in the decision-making process for hospitalizing patients.