Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study

To determine the impact of risk stratification using the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with acute heart failure) scale to guide disposition decision-making on the outcomes of ED patients with acute heart failure (AHF), and assess...

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Autores: Mirò, Òscar, Llorens, Pere, Rosselló, Xavier, Gil, Víctor, Sánchez, Carolina, Jacob, Javier, Herrero-Puente, Pablo, López-Diez, María Pilar, Llauger, Lluis, Romero, Rodolfo, Fuentes, Marta, Tost, Josep, Bibiano, Carlos, Alquézar-Arbé, Aitor, Martín-Mojarro, Enrique, Bueno, Héctor, Peacock, Frank, Martin-Sanchez, Francisco Javier, Pocock, Stuart
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Conselleria de Salut i Consum del Govern de les Illes Balears
Repositorio:Docusalut
Idioma:inglés
OAI Identifier:oai:docusalut.com:20.500.13003/20135
Acceso en línea:https://hdl.handle.net/20.500.13003/20135
Access Level:acceso abierto
Palabra clave:Aftercare
Aged, 80 and over
Male
Prospective Studies
Emergency Service, Hospital
Acute Disease
Adult
Female
Hospital Mortality
Humans
Patient Discharge
Heart Failure
Insuficiencia Cardíaca
Humanos
Estudios Prospectivos
Mortalidad Hospitalaria
Femenino
Anciano de 80 o más Años
Cuidados Posteriores
Servicio de Urgencia en Hospital
Alta del Paciente
Adulto
Enfermedad Aguda
Masculino
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spelling Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after studyMirò, ÒscarLlorens, PereRosselló, XavierGil, VíctorSánchez, CarolinaJacob, JavierHerrero-Puente, PabloLópez-Diez, María PilarLlauger, LluisRomero, RodolfoFuentes, MartaTost, JosepBibiano, CarlosAlquézar-Arbé, AitorMartín-Mojarro, EnriqueBueno, HéctorPeacock, FrankMartin-Sanchez, Francisco JavierPocock, StuartAftercareAged, 80 and overMaleProspective StudiesEmergency Service, HospitalAcute DiseaseAdultFemaleHospital MortalityHumansPatient DischargeHeart FailureAged, 80 and overInsuficiencia CardíacaHumanosEstudios ProspectivosMortalidad HospitalariaFemeninoAnciano de 80 o más AñosCuidados PosterioresServicio de Urgencia en HospitalAlta del PacienteAdultoEnfermedad AgudaMasculinoTo determine the impact of risk stratification using the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with acute heart failure) scale to guide disposition decision-making on the outcomes of ED patients with acute heart failure (AHF), and assess the adherence of emergency physicians to risk stratification recommendations. This was a prospective quasi-experimental study (before/after design) conducted in eight Spanish EDs which consecutively enrolled adult patients with AHF. In the pre-implementation stage, the admit/discharge decision was performed entirely based on emergency physician judgement. During the post-implementation phase, emergency physicians were advised to 'discharge' patients classified by the MEESSI-AHF scale as low risk and 'admit' patients classified as increased risk. Nonetheless, the final decision was left to treating emergency physicians. The primary outcome was 30-day all-cause mortality. Secondary outcomes were days alive and out of hospital, in-hospital mortality and 30-day post-discharge combined adverse event (ED revisit, hospitalisation or death). The pre-implementation and post-implementation cohorts included 1589 and 1575 patients, respectively (median age 85 years, 56% females) with similar characteristics, and 30-day all-cause mortality was 9.4% and 9.7%, respectively (post-implementation HR=1.03, 95% CI=0.82 to 1.29). There were no differences in secondary outcomes or in the percentage of patients entirely managed in the ED without hospitalisation (direct discharge from the ED, 23.5% vs 24.4%, OR=1.05, 95% CI=0.89 to 1.24). Adjusted models did not change these results. Emergency physicians followed the MEESSI-AHF-based recommendation on patient disposition in 70.9% of cases (recommendation over-ruling: 29.1%). Physicians were more likely to over-rule the recommendation when 'discharge' was recommended (56.4%; main reason: need for hospitalisation for a second diagnosis) than when 'admit' was recommended (12.8%; main reason: no appreciation of severity of AHF decompensation by emergency physician), with an OR for over-ruling the 'discharge' compared with the 'admit' recommendation of 8.78 (95% CI=6.84 to 11.3). Implementing the MEESSI-AHF risk stratification tool in the ED to guide disposition decision-making did not improve patient outcomes.BMJ20232023-12-2220232023-12-22research articlehttp://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/20.500.13003/20135reponame:Docusalutinstname:Conselleria de Salut i Consum del Govern de les Illes BalearsInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:docusalut.com:20.500.13003/201352026-06-22T12:44:07Z
dc.title.none.fl_str_mv Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
title Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
spellingShingle Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
Mirò, Òscar
Aftercare
Aged, 80 and over
Male
Prospective Studies
Emergency Service, Hospital
Acute Disease
Adult
Female
Hospital Mortality
Humans
Patient Discharge
Heart Failure
Aged, 80 and over
Insuficiencia Cardíaca
Humanos
Estudios Prospectivos
Mortalidad Hospitalaria
Femenino
Anciano de 80 o más Años
Cuidados Posteriores
Servicio de Urgencia en Hospital
Alta del Paciente
Adulto
Enfermedad Aguda
Masculino
title_short Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
title_full Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
title_fullStr Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
title_full_unstemmed Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
title_sort Impact of the MEESSI-AHF tool to guide disposition decision-making in patients with acute heart failure in the emergency department: a before-and-after study
dc.creator.none.fl_str_mv Mirò, Òscar
Llorens, Pere
Rosselló, Xavier
Gil, Víctor
Sánchez, Carolina
Jacob, Javier
Herrero-Puente, Pablo
López-Diez, María Pilar
Llauger, Lluis
Romero, Rodolfo
Fuentes, Marta
Tost, Josep
Bibiano, Carlos
Alquézar-Arbé, Aitor
Martín-Mojarro, Enrique
Bueno, Héctor
Peacock, Frank
Martin-Sanchez, Francisco Javier
Pocock, Stuart
author Mirò, Òscar
author_facet Mirò, Òscar
Llorens, Pere
Rosselló, Xavier
Gil, Víctor
Sánchez, Carolina
Jacob, Javier
Herrero-Puente, Pablo
López-Diez, María Pilar
Llauger, Lluis
Romero, Rodolfo
Fuentes, Marta
Tost, Josep
Bibiano, Carlos
Alquézar-Arbé, Aitor
Martín-Mojarro, Enrique
Bueno, Héctor
Peacock, Frank
Martin-Sanchez, Francisco Javier
Pocock, Stuart
author_role author
author2 Llorens, Pere
Rosselló, Xavier
Gil, Víctor
Sánchez, Carolina
Jacob, Javier
Herrero-Puente, Pablo
López-Diez, María Pilar
Llauger, Lluis
Romero, Rodolfo
Fuentes, Marta
Tost, Josep
Bibiano, Carlos
Alquézar-Arbé, Aitor
Martín-Mojarro, Enrique
Bueno, Héctor
Peacock, Frank
Martin-Sanchez, Francisco Javier
Pocock, Stuart
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv Aftercare
Aged, 80 and over
Male
Prospective Studies
Emergency Service, Hospital
Acute Disease
Adult
Female
Hospital Mortality
Humans
Patient Discharge
Heart Failure
Aged, 80 and over
Insuficiencia Cardíaca
Humanos
Estudios Prospectivos
Mortalidad Hospitalaria
Femenino
Anciano de 80 o más Años
Cuidados Posteriores
Servicio de Urgencia en Hospital
Alta del Paciente
Adulto
Enfermedad Aguda
Masculino
topic Aftercare
Aged, 80 and over
Male
Prospective Studies
Emergency Service, Hospital
Acute Disease
Adult
Female
Hospital Mortality
Humans
Patient Discharge
Heart Failure
Aged, 80 and over
Insuficiencia Cardíaca
Humanos
Estudios Prospectivos
Mortalidad Hospitalaria
Femenino
Anciano de 80 o más Años
Cuidados Posteriores
Servicio de Urgencia en Hospital
Alta del Paciente
Adulto
Enfermedad Aguda
Masculino
description To determine the impact of risk stratification using the MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with acute heart failure) scale to guide disposition decision-making on the outcomes of ED patients with acute heart failure (AHF), and assess the adherence of emergency physicians to risk stratification recommendations. This was a prospective quasi-experimental study (before/after design) conducted in eight Spanish EDs which consecutively enrolled adult patients with AHF. In the pre-implementation stage, the admit/discharge decision was performed entirely based on emergency physician judgement. During the post-implementation phase, emergency physicians were advised to 'discharge' patients classified by the MEESSI-AHF scale as low risk and 'admit' patients classified as increased risk. Nonetheless, the final decision was left to treating emergency physicians. The primary outcome was 30-day all-cause mortality. Secondary outcomes were days alive and out of hospital, in-hospital mortality and 30-day post-discharge combined adverse event (ED revisit, hospitalisation or death). The pre-implementation and post-implementation cohorts included 1589 and 1575 patients, respectively (median age 85 years, 56% females) with similar characteristics, and 30-day all-cause mortality was 9.4% and 9.7%, respectively (post-implementation HR=1.03, 95% CI=0.82 to 1.29). There were no differences in secondary outcomes or in the percentage of patients entirely managed in the ED without hospitalisation (direct discharge from the ED, 23.5% vs 24.4%, OR=1.05, 95% CI=0.89 to 1.24). Adjusted models did not change these results. Emergency physicians followed the MEESSI-AHF-based recommendation on patient disposition in 70.9% of cases (recommendation over-ruling: 29.1%). Physicians were more likely to over-rule the recommendation when 'discharge' was recommended (56.4%; main reason: need for hospitalisation for a second diagnosis) than when 'admit' was recommended (12.8%; main reason: no appreciation of severity of AHF decompensation by emergency physician), with an OR for over-ruling the 'discharge' compared with the 'admit' recommendation of 8.78 (95% CI=6.84 to 11.3). Implementing the MEESSI-AHF risk stratification tool in the ED to guide disposition decision-making did not improve patient outcomes.
publishDate 2023
dc.date.none.fl_str_mv 2023
2023-12-22
2023
2023-12-22
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/20.500.13003/20135
url https://hdl.handle.net/20.500.13003/20135
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ
publisher.none.fl_str_mv BMJ
dc.source.none.fl_str_mv reponame:Docusalut
instname:Conselleria de Salut i Consum del Govern de les Illes Balears
instname_str Conselleria de Salut i Consum del Govern de les Illes Balears
reponame_str Docusalut
collection Docusalut
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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