Open AccessThe EPICTER score: a bedside and easy tool to predict mortality at 6 months in acute heart failure
Author(s) -
RomeroCorrea Miriam,
SalamancaBautista Prado,
BilbaoGonzález Amaia,
QuirósLópez Raul,
NietoMartín Maria Dolores,
MartínJiménez María Luisa,
MoralesRull José Luis,
QuilesGarcía Dolores,
GómezGigirey Adriana,
Formiga Francesc,
AramburuBodas Óscar,
AriasJiménez José Luis
Publication year - 2022
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13924
Subject(s) - medicine , heart failure , cohort , comorbidity , prospective cohort study , ejection fraction , population , palliative care , cohort study , nursing , environmental health
Aims Estimating the prognosis in heart failure (HF) is important to decide when to refer to palliative care (PC). Our objective was to develop a tool to identify the probability of death within 6 months in patients admitted with acute HF. Methods and results A total of 2848 patients admitted with HF in 74 Spanish hospitals were prospectively included and followed for 6 months. Each factor independently associated with death in the derivation cohort (60% of the sample) was assigned a prognostic weight, and a risk score was calculated. The accuracy of the score was verified in the validation cohort. The characteristics of the population were as follows: advanced age (mean 78 years), equal representation of men and women, significant comorbidity, and predominance of HF with preserved ejection fraction. During follow‐up, 753 patients (26%) died. Seven independent predictors of mortality were identified: age, chronic obstructive pulmonary disease, cognitive impairment, New York Heart Association class III–IV, chronic kidney disease, estimated survival of the patient less than 6 months, and acceptance of a palliative approach by the family or the patient. The area under the ROC curve for 6 month death was 0.74 for the derivation and 0.68 for the validation cohort. The model showed good calibration (Hosmer and Lemeshow test, P value 0.11). The 6 month death rates in the score groups ranged from 6% (low risk) to 54% (very high risk). Conclusions The EPICTER score, developed from a prospective and unselected cohort, is a bedside and easy‐to‐use tool that could help to identify high‐risk patients requiring PC.