Predicting Heart Failure Death in the ER

Ten pieces of information often gathered in the ER may be able to predict the risk of death for people with heart failure within seven days of presentation.

The new tool is called the Emergency Heart Failure Mortality Risk Grade (EHMRG).  To develop the tool lead researcher Douglas Lee, MD, PhD, of the Institute for Clinical Evaluative Sciences in Toronto, and colleagues examined three years’ worth of data from 12,591 heart failure patients in 86 hospitals in Ontario, Canada, from 2004 to 2007.

Within seven days of presentation 2% of the patients had died.  Researchers looked for common links—everything from medications, to lab values and transportation.  After adjustments were made, the 10 factors significantly associated with a greater risk of death in the first week were:

• Older age
• Transportation by emergency medical services
• Lower triage systolic blood pressure
• Higher triage heart rate
• Reduced oxygen saturation
• Higher creatinine
• Potassium level of 4.6 mmol/L or higher
• Elevated serum troponin
• Active cancer
• Use of metolazone at home

The researchers noted limitations of the study, especially the lack of information about left ventricular ejection fractions and brain natriuretic peptide.  The authors also noted that, “Symptomatic improvement, ability of the patient to seek follow-up care, and social circumstances should also be considered, along with quantification of acute prognosis.”  They indicated that the tool is not for use in patients who have chronic, symptomatically stable heart failure.

Lee is applying for a U.S. patent.

For more details or to read the entire study see the June 5 issue of the Annals of Internal Medicine, Prediction of Heart Failure Mortality in Emergent Care. 

This article was originally published in Pathways Physician & Health Professional Bulletin - Issue 25.  To download this issue in PDF format, or past issues, visit our newsletter archives online at www.pathwayshealth.org/publications.