Prediction of Early Adverse Events in Emergency Department Patients With Acute Heart Failure: A Systematic Review

Background: Acute heart failure (AHF) accounts for a substantial proportion of Emergency Department (ED) visits and hospitalizations. Previous studies have shown that emergency physicians' clinical gestalt is not sufficient to stratify patients with AHF into severe and requiring hospitalization vs nonsevere and safe to be discharged. Various prognostic algorithms have been developed to risk-stratify patients with AHF, however there is no consensus as to the best-performing risk assessment tool in the ED. Methods: A systematic review of Medline, PubMed, and Embase up to May 2016 was conducted using established methods. Major cardiology and emergency medicine conference proceedings from 2010 to 2016 were also screened. Two independent reviewers identified studies that evaluated clinical risk scores in adult (ED) patients with AHF, with risk prognostication for mortality or significant morbidity within 7-30 days. Studies included patients who were discharged or admitted. Results: The systematic review search generated 2950 titles that were screened according to title and abstract. Nine articles, describing 6 risk prediction tools met full inclusion criteria, however, prognostic performance and ease of bedside application is limited for most. Because of clinical heterogeneity in the prognostic tools and study outcomes, a meta-analysis was not performed. Conclusions: Several risk scores exist for predicting short-term mortality or morbidity in ED patients with AHF. No single risk tool is clearly superior, however, the Emergency Heart Failure Mortality Risk Grade might aid in prognostication of mortality and the Ottawa Heart Failure Risk Score might provide useful prognostic information in patients suitable for ED discharge.