Article Text

Download PDFPDF
Validating the acute heart failure index for patients presenting to the emergency department with decompensated heart failure
  1. James Hsiao1,
  2. Michelle Motta2,
  3. Peter Wyer2
  1. 1Emergency Department, Sharp Grossmont Hospital, San Diego, California, USA
  2. 2Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
  1. Correspondence to Dr James Hsiao, 575 6th Avenue, #1604, San Diego, CA 92101, USA; james_j_hsiao{at}


Background The acute heart failure index (AHFI) is a previously derived prediction rule to identify patients presenting to emergency departments (ED) with decompensated heart failure (DHF) at low risk of early life-threatening events.

Study objectives To validate the AHFI prospectively.

Methods Using a prospective cohort study, adult patients presenting to an urban university hospital ED with DHF were included. Data on 21 variables were gathered to calculate the AHFI. Primary endpoints included inpatient death and non-fatal serious outcomes (myocardial infarction, ventricular fibrillation, cardiogenic shock, cardiac arrest, intubation, or cardiac reperfusion). Secondary endpoints included death from any cause or readmission for heart failure within 30 days. Primary and secondary endpoint rates were calculated with 95% CI for the low and higher-risk subgroups.

Results 259 patients were enrolled. 245/259 (95%) were admitted. 60/259 (23%) met low-risk criteria, of whom 1/60 (1.7%, CI 0.04 to 8.9) was discharged after sustaining pulseless electrical activity arrest. The comparable primary outcome rate in the derivation study was 1.4% (CI 1.1 to 1.7). 17/199 (8.5%, CI 5.1 to 13.3) higher-risk patients experienced an endpoint, compared with 13.3% (CI 12.9 to 13.7) in the derivation cohort. One low-risk patient (1.7%, CI 0.04 to 8.9) died within 30 days, and five (8.3%, CI 2.8 to 18.4) were readmitted. Corresponding rates in the derivation study were 2% and 5%, respectively.

Conclusion The results are consistent with those previously reported for the low-risk subgroup of the AHFI. Further research is needed to determine the impact, safety and full range of generalisability of the AHFI as an adjunct to decision making.

  • Acute heart failure index
  • clinical prediction rule
  • heart failure

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding This study was made possible by grant number UL1 RR024156 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Institutional Review Board of Columbia University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.