Background: The MEESSI-AHF (Multiple Estimation of Risk based on the Emergency Department Spanish Score In patients with Acute Heart Failure) score is a risk-stratification tool that includes systolic blood pressure, age, NT-proBNP, potassium, cardiac troponin T, New York Heart Association class 4 disease, respiratory rate, low-output symptoms, oxygen saturation, episode associated with acute coronary syndrome, signs of left ventricular hypertrophy on EKG, creatinine, and Barthel Index Score. Prior research has shown that it accurately risk-stratified ED patients with AHF in Spain. It has not been studied in other populations.
Dr. Shree Radhakrishnan
Study design: Prospective multicenter cohort study.
Setting: Adult ED patients with acute dyspnea in four hospitals in Switzerland.
Synopsis: The study included 1,247 nonhemodialysis patients who presented to the ED with acute dyspnea, were found to have all the necessary variables to calculate the MEESSI-AHF score, and were adjudicated to have acute heart failure. The authors calculated a modified MEESSI-AHF score, excluding the Barthel Index for all patients. The authors found that a six-group modified MEESSI-AHF risk-stratification model could predict 30-day mortality with excellent discrimination (C-Statistic, 0.80). Limitations of the study include the exclusion of all hemodynamically unstable patients and those on hemodialysis.
Bottom line: The MEESSI-AHF score effectively predicts 30-day mortality in AHF in Swiss and Spanish ED patients.
Citation: Wussler D et al. External validation of the MEESSI acute heart failure risk score: A cohort study. Ann Intern Med. 2019;170:248-56.
Dr. Radhakrishnan is a hospitalist at Beth Israel Deaconess Medical Center.