Effect of Barthel Index on the Risk of Thirty-Day Mortality in Patients With Acute Heart Failure Attending the Emergency Department: A Cohort Study of Nine Thousand Ninety-Eight Patients From the Epidemiology of Acute Heart Failure in Emergency Departments Registry.

February 19, 2019

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Publicated to: Annals Of Emergency Medicine. 73 (6): 589-598 - 2019-06-01 73(6), DOI: 10.1016/j.annemergmed.2018.12.009

Authors: Rossello, Xavier; Miro, Oscar; Llorens, Pere; Jacob, Javier; Herrero-Puente, Pablo; Gil, Victor; Rizzi, Miguel A; Perez-Dura, Maria J; Espiga, Fernando R; Romero, Rodolfo; Sevillano, Jose A; Vidan, Maria T; Bueno, Hector; Pocock, Stuart J; Martin-Sanchez, Francisco J; Fuentes, Marta; Gil, Cristina; Alonso, Hector; Garmila, Pablo; Rodriguez Adrada, Esther; Llopis Garcia, Guillermo; Cecilia Yanez-Palma, M; Iglesias Lopez, Sergio; Escoda, Rosa; Xipell, Carolina; Sanchez, Carolina; Ma Gaytan, Josep; Jose Perez-Dura, Maria; Salvo, Eva; Pavon, Jose; Noval, Antonio; Torres, Jose M; Luisa Lopez-Grima, Maria; Valero, Amparo; Angeles Juan, Marian; Aguirre, Alfons; Errasti Morales, Julian; Minguez Mas, Silvia; Isabel Alonso, Maria; Ruiz, Francisco; Miguel Franco, Jose; Diaz, Elena; Belen Mecina, Ana; Tost, Josep; Sanchez, Susana; Carbajosa, Virginia; Pinera, Pascual; Sanchez Nicolas, Jose Andres; Torres Garate, Raquel; Alquezar, Aitor; Alberto Rizzi, Miguel; Herrera, Sergio; Roset, Alex; Cabello, Irene; Richard, Fernando; Alvarez Perez, Jose Maria; Lopez Diez, Maria Pilar; Vazquez Alvarez, Joaquin; Alonso Morilla, Ana; Irimia, Andrea; Javaloyes, Patricia; Marquina, Victor; Jimenez, Inmaculada; Hernandez, Nestor; Brouzet, Benjamin; Ramos, Sergio; Lopez, Ana; Antonio Andueza, Juan; Antonio Sevillano, Jose; Calvache, Roberto; Teresa Lorca, Maria; Calderon, Luis; Amores Arriaga, Beatriz; Sierra, Beatriz; Martin Mojarro, Enrique; Traveria Becquer, Lisette; Burillo, Guillermo; Llauger Garcia, Lluis; Corominas LaSalle, Gerard; Aguera Urbano, Carmen; Belen Garcia, Ana; Delgado Padial, Soto Elisa; Soy Ferrer, Ester; Garrido, Manuel; Javier Lucas, Francisco; Gaya, Rut

Affiliations

CIBER Enfermedades CardioVasc CIBERCV, Madrid, Spain - Author

Consorci Sanitari Terrassa, Barcelona, Spain - Author

Ctr Nacl Invest Cardiovasc Carlos III CNIC, Madrid, Spain - Author

Hosp Alcorcon, Alcorcon, Spain - Author

Hosp Clin Barcelona, Barcelona, Spain - Author

Hosp Clin Barcelona, Emergency Dept, Barcelona, Catalonia, Spain - Author

Hosp Clin Lozano Blesa Zaragoza, Zaragoza, Spain - Author

Hosp Clin San Carlos, Madrid, Spain - Author

Hosp Costa Sol Marbella, Malaga, Spain - Author

Hosp Dr Negrin Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain - Author

Hosp Dr Peset Valencia, Valencia, Spain - Author

Hosp Fe Valencia, Short Stay Unit, Emergency Dept, Valencia, Comunidad Valen, Spain - Author

Hosp Gen Albacete, Albacete, Spain - Author

Hosp Gen Alicante, Alicante, Spain - Author

Hosp Gen Alicante, Short Stay Unit & Home Hospitalizat, Emergency Dept, Alicante, Comunidad Valen, Spain - Author

Hosp Gen Univ Gregorio Maranon Madrid, Madrid, Spain - Author

Hosp Gen Univ Gregorio Maranon, Dept Geriatr Med, Madrid, Spain - Author

Hosp Gen Univ Gregorio Maranon, Emergency Dept, Madrid, Spain - Author

Hosp Getafe Madrid, Madrid, Spain - Author

Hosp Henares Madrid, Madrid, Spain - Author

Hosp Insular Las Palmas de Gran Canaria, Las Palmas Gran Canaria, Spain - Author

Hosp Josep Trueta Girona, Girona, Spain - Author

Hosp Juan XXIII Tarragona, Tarragona, Spain - Author

Hosp La Fe Valencia, Valencia, Spain - Author

Hosp Mar Barcelona, Barcelona, Spain - Author

Hosp Marques Valdecilla, Santander, Spain - Author

Hosp Miguel Servet Zaragoza, Zaragoza, Spain - Author

Hosp Reina Sofia Cordoba, Cordoba, Spain - Author

Hosp Reina Sofia Murcia, Murcia, Spain - Author

Hosp Rio Ortega Valladolid, Valladolid, Spain - Author

Hosp San Juan Alicante, Alicante, Spain - Author

Hosp Santa Creu & St Pau Barcelona, Barcelona, Spain - Author

Hosp Severo Ochoa, Madrid, Spain - Author

Hosp St Pau & Santa Tecla Tarragona, Tarragona, Spain - Author

Hosp Tajo Madrid, Madrid, Spain - Author

Hosp Univ Bellvitge, Barcelona, Spain - Author

Hosp Univ Bellvitge, Emergency Dept, Lhospitalet De Llobregat, Catalonia, Spain - Author

Hosp Univ Burgos, Burgos, Spain - Author

Hosp Univ Burgos, Short Stay Unit, Emergency Dept, Burgos, Castilla & Leon, Spain - Author

Hosp Univ Canarias Tenerife, Tenerife, Spain - Author

Hosp Univ Cent Asturias, Emergency Dept, Oviedo, Asturias, Spain - Author

Hosp Univ Cent Asturias, Oviedo, Spain - Author

Hosp Univ Salamanca, Salamanca, Spain - Author

Hosp Univ Vic Barcelona, Barcelona, Spain - Author

Hosp Valme Sevilla, Seville, Spain - Author

Hosp Virgen Macarena Sevilla, Seville, Spain - Author

London Sch Hyg & Trop Med, London, England - Author

Neuroscience. Neuroscience Program. Neurologic Diseases and Neurogenetics - Author

Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Emergency Dept, Barcelona, Catalonia, Spain - Author

Univ Complutense Madrid, CIBER Fragilidad & Envejecimiento, Inst Invest IiSGM, Madrid, Spain - Author

Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Hosp Clin San Carlos, Emergency Dept, Madrid, Spain - Author

Univ Complutense, Fac Med, Madrid, Spain - Author

Univ Complutense, Hosp Univ 12 Octubre Imasl2, Cardiol Dept, Madrid, Spain - Author

Univ Complutense, Hosp Univ 12 Octubre Imasl2, Inst Invest, Madrid, Spain - Author

Univ Europea, Sch Biomed & Hlth Sci, Hosp Univ Getafe, Emergency Dept, Madrid, Spain - Author

Abstract

We assess the value of the Barthel Index (BI) in predicting 30-day mortality risk among patients with acute heart failure who are attending the emergency department (ED).We selected 9,098 acute heart failure patients from the Acute Heart Failure in Emergency Departments registry who had BI score available both at baseline and the ED visit. Patients' data were collected from 41 Spanish hospitals during four 1- to 2-month periods between 2009 and 2016. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and BI score. c Statistics were used to estimate their prognostic value.The mean baseline BI score was 79.4 (SD 24.6) and the mean ED BI score was 65.3 (SD 29.1). Acute functional decline (?5-point decrease between baseline BI and ED BI score) was observed in 5,771 patients (53.4%). Within 30 days of the ED visit, 905 patients (9.9%) died. There was a steep inverse gradient in 30-day mortality risk for baseline BI and ED BI score. For instance, compared with BI score=100, a BI score of 50 to 55 doubled the mortality risk both at baseline and the ED visit. At the ED visit, a BI score of 0 to 5 carried a 5-fold increase in risk after adjustment for other risk predictors. In comparison with baseline BI score, ED BI score consistently provided greater discrimination. Neither baseline BI score nor the change in BI score from baseline to the ED visit added further prognostic value to the ED BI score.Functional status assessed by the BI score at the ED visit is a strong predictor of 30-day mortality in acute heart failure patients, with higher predictive value than baseline BI score and acute functional decline. Routine recording of BI score at the ED visit may help in decisionmaking and health care planning.Copyright © 2018 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Keywords

Good health and well-being

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Annals Of Emergency Medicine due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2019, it was in position 1/31, thus managing to position itself as a Q1 (Primer Cuartil), in the category Emergency Medicine. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.9. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-12-15, the following number of citations:

WoS: 22
Scopus: 8
Europe PMC: 4
Google Scholar: 34
Open Alex: 29

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United Kingdom.

Awards linked to the item

By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org).The authors have stated that no such relationships exist. This study was partially supported by grants from the Instituto de Salud Carlos III, supported with funds from the Spanish Ministry of Health and Fondo Europeo de Desarrollo Regional (PI15/00773 and PI15/01019) and Fundacio La Marato de TV3 (2015/2510). The Emergencies: Processes and Pathologies research group of the Institut d'Investigacions Biomediques August Pi i Sunyer receives financial support from the Catalonian Government for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313). Dr. Rossello reports receiving support from the SEC-CNIC CARDIOJOVEN fellowship program.

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