External validation of the ACUTE HF score in patients hospitalized for acute decompensated heart failure

Published:November 20, 2020DOI:



      Recently, the ACUTE HF score has been developed as a new tool for predicting short and long term mortality in patients with acute heart failure (AHF). However, this.
      score has not yet been validated externally. The present study aimed to investigate the prognostic value of ACUTE HF score in a different patient cohort.


      We retrospectively enrolled all consecutive adult patients hospitalized due to AHF between January 2016 and January 2019. The ACUTE HF score is calculated by 7 different variables including age, creatinine, non-invasive ventilation, history of stroke or transient ischemic attack, left ventricular systolic function, mitral regurgitation and history of hospitalization.The primary endpoint of the study was in-hospital mortality.


      A total of 418 AHF patients (mean age 70.2 ± 11.3 years, 52% male) were included, and 26 (6.2%) patients died during the in-hospital course. Patients in the study were divided into three groups according to ACUTE HF score: low-risk (<1.5, n = 210), intermediate-risk (1.5–3, n = 50), and high-risk groups (>3, n = 158). The multivariate analysis showed that the ACUTE HF score was an independent predictor of in-hospital mortality(OR: 2.15; 95% CI, 0.94–4.34; p < 0.001).


      The ACUTE HF score was a useful prognostic score for the prediction of in-hospital mortality in patients with AHF. Further validation studies in different regions of the world and with different AHF populations are needed to determine its generalisability.


      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Teerlink J.R.
        • Alburikan K.
        • Metra M.
        • Rodgers J.E.
        Acute decompensated heart failure update.
        Curr Cardiol Rev. 2015; 11: 53-62
        • Sasaki N.
        • Kunisawa S.
        • Ikai H.
        • Imanaka Y.
        Differences between determinants of in-hospital mortality and hospitalisation costs for patients with acute heart failure: a nationwide observational study from Japan.
        BMJ Open. 2017 Mar 22; 7: e013753
        • van den Berge J.C.
        • Akkerhuis M.K.
        • Constantinescu A.A.
        • Kors J.A.
        • van Domburg R.T.
        • Deckers J.W.
        Temporal trends in long-term mortality of patients with acute heart failure: data from 1985–2008.
        Int J Cardiol. 2016 Dec 1; 224: 456-460
        • Eren M.
        • Zoghi M.
        • Tuncer M.
        • Çavuşoğlu Y.
        • Demirbağ R.
        • Şahin M.
        • et al.
        Turkish registry for diagnosis and treatment of acute heart failure: TAKTIK study.
        Turk Kardiyol Dern Ars. 2016 Dec; 44: 637-646
        • Fonarow G.C.
        • Adams Jr., K.F.
        • Abraham W.T.
        • Yancy C.W.
        • Boscardin W.J.
        Adhere scientific advisory committee, study group, and investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis.
        JAMA. 2005; 293: 572-580
        • Lee D.S.
        • Austin P.C.
        • Rouleau J.L.
        • Liu P.P.
        • Naimark D.
        • Tu J.V.
        Predicting mortality among patients hospitalized for heart failure: derivationand validation of a clinical model.
        JAMA. 2003; 290: 2581-2587
        • Eapen Z.J.
        • Liang L.
        • Fonarow G.C.
        • Heidenreich P.A.
        • Curtis L.H.
        • Peterson E.D.
        • et al.
        Validated, electronic health record deployable prediction models for assessing patient risk of 30-day rehospitalization and mortality in older heart failure patients.
        JACC Heart Fail. 2013; 1: 245-251
        • Peterson P.N.
        • Rumsfeld J.S.
        • Liang L.
        • Albert N.M.
        • Hernandez A.F.
        • Peterson E.D.
        • et al.
        American Heart Association Get With the Guidelines-Heart Failure Program. A validated risk score for inhospital mortality in patients with heart failure from the American Heart Association get with the guidelines program.
        Circ Cardiovasc Qual Outcomes. 2010; 3: 25-32
        • Cameli M.
        • Pastore M.C.
        • De Carli G.
        • Henein M.Y.
        • Mandoli G.E.
        • Lisi E.
        • et al.
        ACUTE HF score, a multiparametric prognostic tool for acute heart failure: a real-life study.
        Int J Cardiol. 2019 Dec 1; 296: 103-108
        • Levey A.S.
        • Coresh J.
        • Greene T.
        • et al.
        Chronic Kidney Disease EpidemiologyCollaboration. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values.
        ClinChem. 2007; 53: 766-772
        • Maggioni A.P.
        • Dahlström U.
        • Filippatos G.
        • Chioncel O.
        • Leiro M.C.
        • Drozdz J.
        • et al.
        EURObservational research programme: the heart failure pilot survey (ESC-HF pilot).
        Eur J Heart Fail. 2010; 12: 1076-1084
        • Follath F.
        • Yilmaz M.
        • Delgado J.
        • Parissis J.
        • Porcher R.
        • Gayat E.
        • et al.
        Clinical presentation, management and outcomes in the acute heart failure global survey of standard treatment (ALARM-HF).
        Intensive Care Med. 2011; 37: 619-626
        • Ponikowski P.
        • Voors A.A.
        • Anker S.D.
        • Bueno H.
        • Cleland J.G.
        • Coats A.J.
        • et al.
        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 J Heart Fail. 2016 Aug; 18: 891-975
        • Wang N.
        • Hales S.
        Tofler G.15-year trends in patients hospitalised with heart failure and enrolled in an Australian heart failure management program.
        Heart Lung Circ. 2019 Nov; 28: 1646-1654
        • Passantino A.
        • Monitillo F.
        • Iacoviello M.
        • Scrutinio D.
        Predicting mortality in patients with acute heart failure: role of risk scores.
        World J Cardiol. 2015 Dec 26; 7: 902-911
        • Lagu T.
        • Pekow P.S.
        • Shieh M.S.
        • Stefan M.
        • Pack Q.R.
        • Kashef M.A.
        • et al.
        Validation and comparison of seven mortality prediction models for hospitalized patients with acute decompensated heart failure.
        Circ Heart Fail. 2016; 9 (pii: e002912)
        • Onat A.
        • Murat S.N.
        • Ciçek G.
        • Ayhan E.
        • Ornek E.
        • Kaya H.
        • et al.
        Regional distribution of all-cause mortality and coronary disease incidence in Turkey: findings of Turkish Adult Risk Factor survey 2010.
        Turk Kardiyol Dern Ars. 2011; 39: 263-268
        • Ural D.
        • Çavuşoğlu Y.
        • Eren M.
        • Karaüzüm K.
        • Temizhan A.
        • Yılmaz M.B.
        • et al.
        Diagnosis and management of acute heart failure.Anatol.
        J Cardiol. 2015 Nov; 15: 860-889
        • Değertekin M.
        • Erol C.
        • Ergene O.
        • Tokgözoğlu L.
        • Aksoy M.
        • Erol M.K.
        • et al.
        Heart failure prevalence and predictors in Turkey: HAPPY study.
        Turk Kardiyol Dern Ars. 2012; 40: 298-308