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Head-to-head comparison of diagnostic scores for acute heart failure in the emergency department: results from the PARADISE cohort

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Abstract

BREST and PREDICA scores have recently emerged for the diagnosis of acute heart failure (AHF) in the emergency department (ED). This study aimed to perform a head-to-head comparison in a large contemporary cohort. BREST and PREDICA scores were calculated from, respectively, 11 and 8 routine clinical variables recorded in the ED in 1386 patients from the PArADIsE cohort. The diagnostic performance of the scores for adjudicated AHF diagnosis was assessed by the area under the ROC curve (AUC). Acute HF diagnosis was adjudicated according to the European Society of Cardiology criteria and BNP levels. A BREST score ≤ 3 or PREDICA score ≤ 1 was associated with low probabilities of AHF (5.7% and 2.6%, respectively). Conversely, a BREST score ≥ 9 or PREDICA score ≥ 5 was associated with a high risk of AHF diagnosis (77.3% and 66.9%, respectively) although more than half of the population was within the “gray zone” (4–8 and 2–4 for the BREST and PREDICA scores, respectively). Diagnostic performances of both scores were good (AUC 79.1%, [66.1–82.1] for the BREST score and 82.4%, [79.8–85.0] for the PREDICA score). PREDICA score had significantly higher diagnostic performance than BREST score (increase in AUC 3.3 [0.8–5.8], p = 0.009). Our study emphasizes the good diagnostic performance of both BREST and PREDICA scores, albeit with a significantly higher diagnostic performance of the PREDICA score. Yet, more than half of the population was classified within the “gray zone” by these scores; additional diagnostic tools are needed to ascertain AHF diagnosis in the ED in a majority of patients. Clinical trial registration: NCT02800122.

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Data are available upon reasonable request to the principal investigators of the studies.

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References

  1. Khera R, Pandey A, Ayers CR et al (2017) Contemporary epidemiology of heart failure in fee-for-service medicare beneficiaries across healthcare settings. Circ Heart Fail. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004402

    Article  PubMed  PubMed Central  Google Scholar 

  2. Van Aelst LNL, Arrigo M, Placido R et al (2017) Acutely decompensated heart failure with preserved and reduced ejection fraction present with comparable haemodynamic congestion. Eur J Heart Fail. https://doi.org/10.1002/ejhf.1050

    Article  PubMed  Google Scholar 

  3. Chouihed T, Manzo-Silberman S, Peschanski N et al (2016) Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey. Scand J Trauma Resusc Emerg Med 24(1):112. https://doi.org/10.1186/s13049-016-0300-x

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT (2005) Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 294(15):1944–1956. https://doi.org/10.1001/jama.294.15.1944

    Article  CAS  PubMed  Google Scholar 

  5. Ray P, Birolleau S, Lefort Y et al (2006) Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care Lond Engl 10(3):R82. https://doi.org/10.1186/cc4926

    Article  Google Scholar 

  6. Wuerz RC, Meador SA (1992) Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 21(6):669–674

    Article  CAS  PubMed  Google Scholar 

  7. Ponikowski P, Voors AA, Anker SD et al (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128

    Article  PubMed  Google Scholar 

  8. Matsue Y, Damman K, Voors AA et al (2017) Time-to-furosemide treatment and mortality in patients hospitalized with acute heart failure. J Am Coll Cardiol 69(25):3042–3051. https://doi.org/10.1016/j.jacc.2017.04.042

    Article  PubMed  Google Scholar 

  9. Mebazaa A, Yilmaz MB, Levy P et al (2015) Recommendations on pre-hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency: recommendations on pre-hospital & early hospital management of acute heart failure. Eur J Heart Fail 17(6):544–558. https://doi.org/10.1002/ejhf.289

    Article  PubMed  Google Scholar 

  10. Bilben B, Grandal L, Søvik S (2016) National Early Warning Score (NEWS) as an emergency department predictor of disease severity and 90-day survival in the acutely dyspneic patient—a prospective observational study. Scand J Trauma Resusc Emerg Med 24:80. https://doi.org/10.1186/s13049-016-0273-9

    Article  PubMed  PubMed Central  Google Scholar 

  11. Steinhart BD, Levy P, Vandenberghe H et al (2016) A randomized control trial using a validated prediction model for diagnosing acute heart failure in undifferentiated dyspneic emergency department patients-results of the GASP4Ar Study. J Card Fail. https://doi.org/10.1016/j.cardfail.2016.08.007

    Article  PubMed  Google Scholar 

  12. Basset A, Nowak E, Castellant P, Gut-Gobert C, Le Gal G, L’Her E (2016) Development of a clinical prediction score for congestive heart failure diagnosis in the emergency care setting: the Brest score. Am J Emerg Med 34(12):2277–2283. https://doi.org/10.1016/j.ajem.2016.08.023

    Article  PubMed  Google Scholar 

  13. Roncalli J, Picard F, Delarche N et al (2019) Predictive criteria for acute heart failure in emergency department patients with acute dyspnoea: the PREDICA study. Eur J Emerg Med 26(6):400–404. https://doi.org/10.1097/MEJ.0000000000000622

    Article  CAS  PubMed  Google Scholar 

  14. Chouihed T, Rossignol P, Bassand A et al (2018) Diagnostic and prognostic value of plasma volume status at emergency department admission in dyspneic patients: results from the PARADISE cohort. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1388-y

    Article  PubMed  Google Scholar 

  15. Chouihed T, Buessler A, Bassand A et al (2018) Hyponatraemia, hyperglycaemia and worsening renal function at first blood sample on emergency department admission as predictors of in-hospital death in patients with dyspnoea with suspected acute heart failure: retrospective observational analysis of the PARADISE cohort. BMJ Open 8(3):e019557. https://doi.org/10.1136/bmjopen-2017-019557

    Article  PubMed  PubMed Central  Google Scholar 

  16. Eurlings LW, Sanders-van Wijk S, van Kimmenade R et al (2012) Multimarker strategy for short-term risk assessment in patients with dyspnea in the emergency department: the MARKED (Multi mARKer Emergency Dyspnea)-risk score. J Am Coll Cardiol 60(17):1668–1677. https://doi.org/10.1016/j.jacc.2012.06.040

    Article  PubMed  Google Scholar 

  17. Burri E, Hochholzer K, Arenja N et al (2012) B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care. J Intern Med 272(5):504–513. https://doi.org/10.1111/j.1365-2796.2012.02552.x

    Article  CAS  PubMed  Google Scholar 

  18. Möckel M, von Haehling S, Vollert JO et al (2018) Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference? ESC Heart Fail 5(3):309–315. https://doi.org/10.1002/ehf2.12290

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fonarow GC, Peacock WF, Phillips CO, Givertz MM, Lopatin M (2007) ADHERE Scientific Advisory Committee and Investigators. Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol 49(19):1943–1950. https://doi.org/10.1016/j.jacc.2007.02.037

    Article  CAS  PubMed  Google Scholar 

  20. St Peter JV, Hartley GG, Murakami MM, Apple FS (2006) B-type natriuretic peptide (BNP) and N-terminal pro-BNP in obese patients without heart failure: relationship to body mass index and gastric bypass surgery. Clin Chem 52(4):680–685. https://doi.org/10.1373/clinchem.2005.062562

    Article  CAS  PubMed  Google Scholar 

  21. Kebir A, Harhouri K, Guillet B et al (2010) CD146 short isoform increases the proangiogenic potential of endothelial progenitor cells in vitro and in vivo. Circ Res 107(1):66–75. https://doi.org/10.1161/CIRCRESAHA.109.213827

    Article  CAS  PubMed  Google Scholar 

  22. Stalin J, Harhouri K, Hubert L et al (2013) Soluble melanoma cell adhesion molecule (sMCAM/sCD146) promotes angiogenic effects on endothelial progenitor cells through angiomotin. J Biol Chem 288(13):8991–9000. https://doi.org/10.1074/jbc.M112.446518

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Incalzi RA, Fuso L, Serra M et al (2002) Exacerbated chronic obstructive pulmonary disease: a frequently unrecognized condition. J Intern Med 252(1):48–55

    Article  PubMed  Google Scholar 

  24. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby J-J (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100(1):9–15

    Article  PubMed  Google Scholar 

  25. Chakko S, Woska D, Martinez H et al (1991) Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure: conflicting results may lead to inappropriate care. Am J Med 90(3):353–359

    Article  CAS  PubMed  Google Scholar 

  26. Kobayashi M, Bercker M, Huttin O et al (2020) Chest X-ray quantification of admission lung congestion as a prognostic factor in patients admitted for worsening heart failure from the ICALOR cohort study. Int J Cardiol 299:192–198. https://doi.org/10.1016/j.ijcard.2019.06.062

    Article  PubMed  Google Scholar 

  27. Lichtenstein DA, Mezière GA (2008) Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 134(1):117–125. https://doi.org/10.1378/chest.07-2800

    Article  PubMed  PubMed Central  Google Scholar 

  28. Frigerio M, Mazzali C, Paganoni AM et al (2017) Trends in heart failure hospitalizations, patient characteristics, in-hospital and 1-year mortality: a population study, from 2000 to 2012 in Lombardy. Int J Cardiol 236:310–314. https://doi.org/10.1016/j.ijcard.2017.02.052

    Article  PubMed  Google Scholar 

  29. Buessler A, Chouihed T, Duarte K et al (2020) Accuracy of several lung ultrasound methods for the diagnosis of acute heart failure in the ED: a multicenter prospective study. Chest 157(1):99–110. https://doi.org/10.1016/j.chest.2019.07.017

    Article  PubMed  Google Scholar 

  30. Marantz PR, Kaplan MC, Alderman MH (1990) Clinical diagnosis of congestive heart failure in patients with acute dyspnea. Chest 97(4):776–781. https://doi.org/10.1378/chest.97.4.776

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Université de Lorraine, Inserm, Centre d’Investigations Cliniques - 1433, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France

    Tahar Chouihed, Kevin Duarte, Déborah Jaeger, Masatake Kobayashi, Patrick Rossignol & Nicolas Girerd

  2. Emergency Department, University Hospital of Nancy, Vanvoeuvre-Les-Nancy, Nancy, France

    Tahar Chouihed, Adrien Bassand, Déborah Jaeger, Yann Roth, Gaetan Giacomin, Anne Delaruelle & Charlène Duchanois

  3. Université de Lorraine, CHRU-Nancy, Medical Information Department, CNRS, Inria, LORIA, 54000, Nancy, France

    Aurélie Bannay

Authors
  1. Tahar Chouihed
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  2. Adrien Bassand
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  3. Kevin Duarte
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  11. Patrick Rossignol
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Correspondence to Nicolas Girerd.

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Conflict of interest

TC has received honoraria from Novartis for his participation on scientific boards. NG has received honoraria from Boehringer AstraZeneka, Vifor and Novartis for his participation on scientific boards. PR reports personal fees (consulting) for Idorsia and G3P, and honoraria from AstraZeneca, Bayer, Boehringer-Ingelheim, CVRx, Fresenius, Grunenthal, Novartis, NovoNordisk, Servier, Stealth Peptides, Ablative Solutions, Corvidia, Relypsa and Vifor Fresenius Medical Care Renal Pharma, outside the submitted work; P.R. is the cofounder of CardioRenal. All the other authors of this research declare no conflict of interest.

Ethical approval

Under French law, no formal IRB approval is required for data extraction from patients’ medical records in mono-center studies. The PARADISE cohort was approved by the French Commission Nationale Informatique et Libertés (CNIL) under number R2016-08.

Consent to participate

This monocenter retrospective study on patients’ files is in compliance with the Commission Nationale Informatique et Libertés (CNIL). Informed written consent was not required by regulation.

Consent for publication

This monocenter retrospective study on patients’ files is in compliance with the Commission Nationale Informatique et Libertés (CNIL). Informed written consent was not required by regulation.

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Chouihed, T., Bassand, A., Duarte, K. et al. Head-to-head comparison of diagnostic scores for acute heart failure in the emergency department: results from the PARADISE cohort. Intern Emerg Med 17, 1155–1163 (2022). https://doi.org/10.1007/s11739-021-02879-6

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  • DOI: https://doi.org/10.1007/s11739-021-02879-6

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