The EPICTER score: a bedside and easy tool to predict mortality at 6 months in acute heart failure

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...

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Published in:	ESC Heart Failure Vol. 9; no. 4; pp. 2348 - 2356
Main Authors:	Romero‐Correa, Miriam, Salamanca‐Bautista, Prado, Bilbao‐González, Amaia, Quirós‐López, Raul, Nieto‐Martín, Maria Dolores, Martín‐Jiménez, María Luisa, Quiles‐García, Dolores, Gómez‐Gigirey, Adriana, Formiga, Francesc, Aramburu‐Bodas, Óscar, Arias‐Jiménez, José Luis, Choucino‐Fernández, T., Pedrosa‐Fraga, C., Suárez‐Gil, R., González‐Soler, J.J., Ferreira‐González, L., Gallego‐Villalobos, M., Rugeles‐Niño, J.P., Rodríguez‐Avila, E.E., Guerra‐Acebal, C., Sebastián‐Leza, A., Monte‐Armenteros, J., Frutos‐Muñoyerro, G., Clemente‐Sarasa, C., Díez‐Manglano, J., Torres‐Courchoud, I., Gómez‐Aguirre, N., Jordana‐Camajuncosa, R., Cajamarca‐Calva, L.E., Torrente‐Jiménez, I., Serrado‐Iglesias, A., Ceresuela, L.M., Delás‐Amat, J., Petit‐Salas, I., Romaní‐Costa, V., Expósito‐López, A., Sabbagh‐Fajardo, C.E., Recio‐Iglesias, J., Alemán‐Llansó, C., Suriñach‐Caralt, J.M., Trullás‐Vila, J.C., Armengou‐Arxe, A., García‐Torras, S., Solé‐Felip, C., Lacal‐Martínez, A., Muela‐Molinero, A., Arribas‐Arribas, P., Ruiz ‐de Temiño, Á., Fuentes‐Pardo, L., García‐García, M., Piniella‐Ruiz, E., Gonzalo‐Pascua, S., Méndez‐Bailón, M., Martín‐Sánchez, F.J., Varas‐Mayoral, M., Herreros, B., Quesada‐Simón, A., Vives‐Beltrán, I., Álvarez‐Troncoso, J., Martínez‐Marín, L.A., Soler‐Rangel, L., Abellán‐Martínez, J., López‐Castellanos, G.T., Ruiz‐Barraza, E., Arévalo‐Lorido, J.C., Carretero‐Gómez, J., Calderón‐Jiménez, P., Herrero‐Domingo, A., Martín‐Barba, S., Blázquez‐Encinar, J.C., Cepeda‐Rodrigo, J.M., Díez‐García, L.F., Martínez‐Soriano, M.J., Menor, E., Montero‐Pérez‐Barquero, M., Anguita‐Sánchez, M.P., Sánchez‐Moruno, M., Zambrana‐García, J.L., Alcalá‐Pedrajas, J.N., Guzmán‐García, M., Domingo‐Roa, S., García‐Redecillas, C., Antequera‐Martín‐Portugués, I., Blanco‐Soto, M., Aparicio‐Santos, R., Jiménez‐de‐Juan, C., Ternero‐Vega, J., Villalonga‐Comas, M., Díaz‐Cañestro, M., Gil‐Díaz, A., Marrero‐Medina, I., Puente‐Fernández, A., Gudiño‐Aguirre, D., Dávila‐Ramos, M.F., Calderón, E., Fernández‐Martínez, J., Vázquez‐Rodríguez, P., Conde‐Martel, A., López‐Reboiro, M., Sánchez‐Sánchez, C.
Format:	Journal Article
Language:	English
Published:	Oxford John Wiley & Sons, Inc 01-08-2022 John Wiley and Sons Inc Wiley
Subjects:	Advanced heart failure Age Cardiology Clinical medicine Disease Ejection fraction Genetic algorithms Heart failure Hospitals Intensive care Internal medicine Medical prognosis Mortality Original Palliative care Patients Prognosis Risk score Software Variables Spain
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Summary:	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.
ISSN:	2055-5822 2055-5822
DOI:	10.1002/ehf2.13924