External Validation of the MEESSI Acute Heart Failure Risk Score: A Cohort Study.

Background: The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score was developed to predict 30-day mortality in patients presenting with acute heart failure (AHF) to emergency departments (EDs) in Spain. Whether it performs well in other countries is unknown. Objective: To externally validate the MEESSI-AHF score in another country. Design: Prospective cohort study. (ClinicalTrials.gov: NCT01831115). Setting: Multicenter recruitment of dyspneic patients presenting to the ED. Participants: The external validation cohort included 1572 patients with AHF. Measurements: Calculation of the MEESSI-AHF score using an established model containing 12 independent risk factors. Results: Among 1572 patients with adjudicated AHF, 1247 had complete data that allowed calculation of the MEESSI-AHF score. Of these, 102 (8.2%) died within 30 days. The score predicted 30-day mortality with excellent discrimination (c-statistic, 0.80). Assessment of cumulative mortality showed a steep gradient in 30-day mortality over 6 predefined risk groups (0 patients in the lowest-risk group vs. 35 [28.5%] in the highest-risk group). Risk was overestimated in the high-risk groups, resulting in a Hosmer-Lemeshow P value of 0.022. However, after adjustment of the intercept, the model showed good concordance between predicted risks and observed outcomes (P = 0.23). Findings were confirmed in sensitivity analyses that used multiple imputation for missing values in the overall cohort of 1572 patients. Limitations: External validation was done using a reduced model. Findings are specific to patients with AHF who present to the ED and are clinically stable enough to provide informed consent. Performance in patients with terminal kidney failure who are receiving long-term dialysis cannot be commented on. Conclusion: External validation of the MEESSI-AHF risk score showed excellent discrimination. Recalibration may be needed when the score is introduced to new populations. Primary Funding Source: The European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel, and University Hospital Basel.

Outcome of dialysis patients aged seventy years or above--a retrospective analysis.

OBJECTIVE: Due to increased life expectancy, there is a growing number of older patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). However, there is a lack of data with regard to clinical outcomes of these patients. METHODS: In this single-centre study, we retrospectively analysed two groups of patients on chronic haemodialysis, stratified by age. A group of patients ≥70 years of age ("seniors"; n = 69) was compared with a control group of patients 60 to 69 years of age ("elderly"; n = 39). The major outcomes that we investigated were: patient survival, causes of death, and type and frequency of complications. RESULTS: Kaplan-Meier curves revealed only a trend towards better survival in the elderly (p = 0.06). During the observation time, about half of the patients died: 38/69 in the senior group and 14/39 in the elderly group (p = 0.07). The cause of death was mostly unknown. Both groups were affected equally by complications during haemodialysis therapy (p = 0.62). For the severity of complications, the only significant difference was a higher frequency of complications with outpatient treatment in seniors (p = 0.04). However, there were not more severe complications leading to hospitalisation in seniors (p = 0.64). CONCLUSION: Age is not a good predictor for the outcome of patients of 70 years of age or older with ESRD requiring RRT and thus age alone should never guide us in the decision-making process as to whether to start dialysis or not in these patients.