Evidence map›Paper›PMID 30586748›Full record

Trial reportCirculation2019

Prospective Validation of the Emergency Heart Failure Mortality Risk Grade for Acute Heart Failure.

Douglas S Lee, Jacques S Lee, Michael J Schull, Bjug Borgundvaag, Marcia L Edmonds, Maria Ivankovic, Shelley L McLeod, Jonathan F Dreyer, Sam Sabbah, Phillip D Levy and 5 more

2 registry-linked trialsOpen access · hybridAbstract readClinical TrialMulticenter StudyValidation Study
PubMed Publisher
In one paragraph

Trial report in Circulation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 57 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
57citing papers in PubMed, 1 pooled it
9.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02634762 completednot on this map

Acute Congestive Heart Failure Urgent Care Evaluation: Prospective Validation of the Emergency Heart Failure Mortality Risk Grade 7-day and 30-day Algorithms in the Emergency Department

Typeobservational_patient_registrySponsorInstitute for Clinical Evaluative SciencesRan2011 to 2017Enrolled1,983ConditionsHeart Failure
NCT05710302 completednot on this mapstarted 2022, after this paper: background citation

Investigation of the Diagnostic Accuracy of EHMRG Risk Score in Patients With Acute Heart Failure

TypeobservationalSponsorMarmara University Pendik Training and Research HospitalRan2022 to 2023Enrolled239ConditionsHeart Failure, Heart Diseases, Acute Heart FailureArmsInvestigation of the diagnostic accuracy of EHMRG risk score in patients with acute heart failure
3 · Its place in the literature

Who cites it

57 citing papers in PubMed, 1 synthesis or guideline pooled it, 115 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Trial
  4. Trial
  5. Review
  6. Observational
  7. Review
  8. Observational
  9. Observational
  10. FIB-4 index predicts short-term mortality in Vietnamese acute heart failure patients.American heart journal plus : cardiology research and practice · 2026
    Article
  11. Review
  12. Article
  13. Article
  14. Article
  15. Prognostic Models in Heart Failure: Hope or Hype?Journal of personalized medicine · 2025
    Review
  16. Review
  17. Article
  18. Clinical decision instruments for predicting mortality in patients with cirrhosis seeking emergency department care.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2025
    Article
  19. Article
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 8 institutions in 3 countries.

Douglas S LeeICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Jacques S LeeUniversity of Toronto, Ontario, Canada (D.S.L., J.S.L., M.J.S., B.B., S.L.M., S.S., T.A.S., P.C.A., J.V.T.).
Michael J SchullICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Bjug BorgundvaagUniversity of Toronto, Ontario, Canada (D.S.L., J.S.L., M.J.S., B.B., S.L.M., S.S., T.A.S., P.C.A., J.V.T.).
Marcia L EdmondsUniversity of Western Ontario, London, Canada (M.L.E., J.F.D.).
Maria IvankovicTrillium Health Partners, Mississauga, Ontario, Canada (M.I.).
Shelley L McLeodUniversity of Toronto, Ontario, Canada (D.S.L., J.S.L., M.J.S., B.B., S.L.M., S.S., T.A.S., P.C.A., J.V.T.).
Jonathan F DreyerUniversity of Western Ontario, London, Canada (M.L.E., J.F.D.).
Sam SabbahPeter Munk Cardiac Centre and University Health Network, Toronto, Ontario, Canada (D.S.L., S.S.).
Phillip D LevyDepartment of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI (P.D.L.).
Tara O'NeillICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Alice ChongICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Therese A StukelICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Peter C AustinICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Jack V TuICES, Toronto, Ontario, Canada (D.S.L., M.J.S., T.O., A.C., T.A.S., P.C.A., J.V.T.).
Hesco (United States) · USSchwartz/Reisman Emergency Medicine Institute · CASunnybrook Health Science Centre · CAUniversity Health Network · CAWestern University · CASt. Michael's Hospital · CATrillium Health Centre · CAWayne State University · US

Funding

CIHR FDN 148446
6 · The paper itself

Abstract

backgroundImproved risk stratification of acute heart failure in the emergency department may inform physicians' decisions regarding patient admission or early discharge disposition. We aimed to validate the previously-derived Emergency Heart failure Mortality Risk Grade for 7-day (EHMRG7) and 30-day (EHMRG30-ST) mortality.

methodsWe conducted a multicenter, prospective validation study of patients with acute heart failure at 9 hospitals. We surveyed physicians for their estimates of 7-day mortality risk, obtained for each patient before knowledge of the model predictions, and compared these with EHMRG7 for discrimination and net reclassification improvement. We also prospectively examined discrimination of the EHMRG30-ST model, which incorporates all components of EHMRG7 as well as the presence of ST-depression on the 12-lead ECG.

resultsWe recruited 1983 patients seeking emergency department care for acute heart failure. Mortality rates at 7 days in the 5 risk groups (very low, low, intermediate, high, and very high risk) were 0%, 0%, 0.6%, 1.9%, and 3.9%, respectively. At 30 days, the corresponding mortality rates were 0%, 1.9%, 3.9%, 5.9%, and 14.3%. Compared with physician-estimated risk of 7-day mortality (PER7; c-statistic, 0.71; 95% CI, 0.64-0.78) there was improved discrimination with EHMRG7 (c-statistic, 0.81; 95% CI, 0.75-0.87; P=0.022 versus PER7) and with EHMRG7 combined with physicians' estimates (c-statistic, 0.82; 95% CI, 0.76-0.88; P=0.003 versus PER7). Model discrimination increased nonsignificantly by 0.014 (95% CI, -0.009-0.037) when physicians' estimates combined with EHMRG7 were compared with EHMRG7 alone ( P=0.242). The c-statistic for EHMRG30-ST alone was 0.77 (95% CI, 0.73-0.81) and 30-day model discrimination increased nonsignificantly by addition of physician-estimated risk to 0.78 (95% CI, 0.73-0.82; P=0.187). Net reclassification improvement with EHMRG7 was 0.763 (95% CI, 0.465-1.062) when assessed continuously and 0.820 (0.560-1.080) using risk categories compared with PER7.

conclusionsA clinical model allowing simultaneous prediction of mortality at both 7 and 30 days identified acute heart failure patients with a low risk of events. Compared with physicians' estimates, our multivariable model was better able to predict 7-day mortality and may guide clinical decisions. CLINICAL

trial registrationURL: https://www.clinicaltrials.gov . Unique identifier: NCT02634762.

Indexed as

Models, CardiovascularAcute DiseaseAgedAged, 80 and overFemaleHeart FailureHumansMaleProspective StudiesRisk FactorsSurvival RateTime Factorsdecision makingemergency departmentsheart failurehospitalizationmortalityrisk assessmenttreatment outcome

Identifiers

PMID30586748
OpenAlexW2908727577

What OpenQuestion holds

Textmetadata
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.