External Validation of the MEESSI Acute Heart Failure Risk Score: A Cohort Study

February 26, 2019

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Publicated to: Annals Of Internal Medicine. 170 (4): 248-+ - 2019-02-19 170(4), DOI: 10.7326/m18-1967

Authors:

Wussler, Desiree; Kozhuharov, Nikola; Sabti, Zaid; Walter, Joan; Strebel, Ivo; Scholl, Letizia; Miro, Oscar; Rossello, Xavier; Javier Martin-Sanchez, Francisco; Pocock, Stuart J; Nowak, Albina; Badertscher, Patrick; Twerenbold, Raphael; Wildi, Karin; Puelacher, Christian; de Lavallaz, Jeanne du Fay; Shrestha, Samyut; Strauch, Olivia; Flores, Dayana; Nestelberger, Thomas; Boeddinghaus, Jasper; Schumacher, Carmela; Goudev, Assen; Pfister, Otmar; Breidthardt, Tobias; Mueller, Christian

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Affiliations

CIBER Enfermedades Cardiovasc, Madrid, Spain - Author

Ctr Nacl Invest Cardiovasc Carlos III, Calle Melchor Fernandez Almagro 3, Madrid 28029, Spain - Author

London Sch Hyg & Trop Med, Dept Epidemiol & Populat Hlth, Dept Med Stat, Keppel St, London WC1E 7HT, England - Author

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

Med Univ Sofia, Queen Ioanna Univ Hosp Sofia, Dept Cardiol, Byalo More 8 Str, Sofia 1527, Bulgaria - Author

Spital Linth, Uznach, Switzerland - Author

Univ Barcelona, Hosp Clin, Emergency Dept, Villarroel 170, Barcelona 08290, Spain - Author

Univ Complutense, Hosp Clin San Carlos, Emergency Dept, Prof Martin Lagos S-N, Madrid 28020, Spain - Author

Univ Hosp Basel, Cardiovasc Res Inst Basel, Petersgraben 4, CH-4031 Basel, Switzerland - Author

Univ Hosp Basel, Dept Cardiol, Petersgraben 4, CH-4031 Basel, Switzerland - Author

Univ Hosp Zurich, Dept Endocrinol, Dept Psychiat, Zurich, Switzerland - Author

Abstract

The MEESSI-AHF (Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF) score was developed to predict 30-day mortality in patients presenting with acute heart failure (AHF) to emergency departments (EDs) in Spain. Whether it performs well in other countries is unknown.To externally validate the MEESSI-AHF score in another country.Prospective cohort study. (ClinicalTrials.gov: NCT01831115).Multicenter recruitment of dyspneic patients presenting to the ED.The external validation cohort included 1572 patients with AHF.Calculation of the MEESSI-AHF score using an established model containing 12 independent risk factors.Among 1572 patients with adjudicated AHF, 1247 had complete data that allowed calculation of the MEESSI-AHF score. Of these, 102 (8.2%) died within 30 days. The score predicted 30-day mortality with excellent discrimination (c-statistic, 0.80). Assessment of cumulative mortality showed a steep gradient in 30-day mortality over 6 predefined risk groups (0 patients in the lowest-risk group vs. 35 [28.5%] in the highest-risk group). Risk was overestimated in the high-risk groups, resulting in a Hosmer-Lemeshow P value of 0.022. However, after adjustment of the intercept, the model showed good concordance between predicted risks and observed outcomes (P = 0.23). Findings were confirmed in sensitivity analyses that used multiple imputation for missing values in the overall cohort of 1572 patients.External validation was done using a reduced model. Findings are specific to patients with AHF who present to the ED and are clinically stable enough to provide informed consent. Performance in patients with terminal kidney failure who are receiving long-term dialysis cannot be commented on.External validation of the MEESSI-AHF risk score showed excellent discrimination. Recalibration may be needed when the score is introduced to new populations.The European Union, the Swiss National Science Foundation, the Swiss Heart Foundation, the Cardiovascular Research Foundation Basel, the University of Basel, and University Hospital Basel.

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Keywords

Peace, justice and strong institutions

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal ANNALS OF INTERNAL 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 6/165, thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine, General & Internal. 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: 3.67. 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 2026-04-08, the following number of citations:

WoS: 52
Scopus: 14
Europe PMC: 14
Google Scholar: 54
Open Alex: 42

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Leadership analysis of institutional authors

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

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