Maryam Razavi

maryam.razavi@cambio.se

Cambio CDS

To assist clinicians to identify ED patients with heart failure at high risk for serious adverse events.

Use in patients presenting to the emergency department with acute dyspnea secondary to new-onset or chronic heart failure (HF), after the initial intervention. Formula: Addition of the selected points: Variables and assigned points: History: No Yes - Stroke or TIA 0 +1 - Intubation for 0 +2 respiratory distress Examination: - HR ≥110 on ED arrival 0 +2 - SaO2 <90% on arrival 0 +1 - Heart rate ≥110 during 0 +1 3-minutes walk test (or too ill to perform walk test) Investigations: - New ischemic changes 0 +2 on EKG - Urea ≥12 mmol/L 0 +1 - Serum CO2 ≥35 0 +2 mmol/L (mEq/L) - Troponin I or T elevated 0 +2 to MI level - NT-proBNP ≥5,000 0 +1 ng/L (pg/mL) Interpretation: Total Score 0 = 2.8% Risk of Serious Adverse Event (SAE)= Low Category Total Score 1 = 5.1% Risk of Serious Adverse Event (SAE)= Medium Category Total Score 2 = 9.2% Risk of Serious Adverse Event (SAE)= Medium Category Total Score 3 = 15.9% Risk of Serious Adverse Event (SAE)= High Category Total Score 4 = 26.1% Risk of Serious Adverse Event (SAE)= High Category Total Score 5 = 39.8% Risk of Serious Adverse Event (SAE)= Very high Category Total Score 6 = 55.3% Risk of Serious Adverse Event (SAE)= Very high Category Total Score 7 = 69.8% Risk of Serious Adverse Event (SAE)= Very high Category Total Score 8 = 81.2% Risk of Serious Adverse Event (SAE)= Very high Category Total Score 9 = 89.0% Risk of Serious Adverse Event (SAE)= Very high Category Total Score >9 = >89.0% Risk of Serious Adverse Event (SAE)= Very high Category

Not to use prior to ED intervention and in patients who are hemodynamically unstable. Full exclusion criteria are listed below: - Resting O₂ sat <85% on room air on normal home O₂ for >20 minutes. - Heart rate >120 on arrival. - Systolic BP <85 mmHg on arrival. - Confusion, disorientation, or dementia. - Ischemic chest pain requiring nitrates on arrival. - ST segment elevation on EKG. - Death expected within weeks from chronic illness. - Nursing home or chronic care facility resident. - On chronic hemodialysis.

1. Stiell IG, Clement CM, Brison RJ, et al. A risk scoring system to identify emergency department patients with heart failure at high risk for serious adverse events. Acad Emerg Med. 2013;20(1):17-26. 2. Stiell IG, Perry JJ, Clement CM, et al. Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. Acad Emerg Med. 2017;24(3):316-327.

OBSERVATION.ohfrs.v0, EVALUATION.ohfrs_assessment.v0