Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)

Published:March 04, 2020DOI:


      • First episodes and decompensation of chronic heart failure have different prognosis.
      • A score is presented to assess prognosis after the first episode of heart failure.
      • This score needs to be validated in an external cohort prior to implementation.



      Different variables are playing a role in prognosis of acute heart failure.


      Our purpose was to create and validate a risk score to predict mortality in patients with a first episode of acute heart failure during the first 2 months after the first hospitalization.


      This was a prospective cohort study.


      We recruited patients diagnosed with a first episode of acute heart failure.

      Main measures

      We collected data on sociodemographic characteristics; medical history; symptoms; precipitating factors; signs and symptoms of congestion; echocardiographic parameters; aetiology; vital signs and laboratory findings; and response to initial treatment (yes/no). A Cox proportional hazard regression model was built with mortality during the first 2 months after the index episode as the dependent variable. A risk score is presented.

      Key Results

      The mortality rate during the first 2 months after a first episode of heart failure was 5%. Age, systolic blood pressure, serum sodium, ejection fraction and blood urea nitrogen were selected in the internal validation, as was right ventricular failure. A risk score was developed. Both the model and the score showed good discrimination and calibration properties when applied to an independent cohort.


      Our ESSIC-FEHF risk score showed excellent properties in the derivation cohort and also in a cohort from a different time period. This score is expected to help decision making in patients diagnosed with heart failure for the first time.


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