Observational studyESC heart failure2026
Evaluating the temporal and sociodemographic generalizability of the emergency heart failure mortality risk grade.
Observational study in ESC heart failure, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
10 authors.
Funding
Abstract
introductionEmergency Heart Failure Mortality Risk Grade (EHMRG) are a series of models derived in 2004-2007 to predict mortality in acute heart failure (AHF) patients. Although EHMRG models have been validated in Ontario, it remains unknown whether EHMRG maintains temporal validity and performs robustly across different socio-demographic strata.This study aimed to assess the temporal validity of EHMRG models and determine if EHMRG models perform differently across socio-demographic subgroups.
methodsWe selected a sample of 7537 patients presenting to 10 emergency departments with an AHF diagnosis between 2017 and 2019 in Ontario. We linked our cohort to national databases to obtain the Ontario marginalization index (ON-Marg). We calculated the EHMRG-7P (7-day mortality probability) and EHMRG30-ST (30-day mortality) scores for each patient and assessed their performance using discrimination metrics and calibration plots. We then compared EHMRG performance across several socio-demographic subgroups.
resultsIn our temporal validation cohort, EHMRG-7P had a high c-statistic (0.794 [95% CI, 0.764-0.824]) and demonstrated good calibration, with minor overestimation of risk in the highest decile. EHMRG30-ST had a good c-statistic (0.777 [0.759-0.796]) but mildly overestimated risk in the five upper deciles. The discrimination of EHMRG models was robust across subgroups of sex, income quintiles, marital status, and the ON-Marg indices. However, the c-statistic was slightly lower for patients living in long-term-care homes.
conclusionsEHMRG models retained good model discrimination. Risk was mildly overestimated at 30-days for higher-risk patients, which would lead to conservative recommendations tending towards hospital admission. EHMRG models were robust over most socio-demographic characteristics.
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