CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 40 AFRICA Assessment value of the modified early warning score for long-term prognosis of older patients with chronic heart failure Yin Yin, Jie Chen, Shijiu Jiang Abstract Aim: The aim of the study was to explore the assessment value of the modified early warning score (MEWS) for the long-term prognosis of older patients with chronic heart failure (CHF). Methods: A total of 180 CHF patients, treated from January 2016 to January 2018, were divided into a grade I group (n = 28), a grade II group (n = 37), a grade III group (n = 68) and a grade IV group (n = 47) according to the New York Heart Association (NYHA) functional classification. The MEWS was compared on admission and discharge. Based on the clinical outcomes during follow up, the patients were divided into a non-survival group (n = 48) and a survival group (n = 132). Their general clinical data and the MEWS were compared. The predictive values of the MEWS, troponin I (cTnI) and B-type natriuretic (BNP) peptide for long-term prognosis were assessed using receiver operator characteristic (ROC) curves. Results: The MEWS on patient discharge was significantly lower than that on admission, and it increased with increasing NYHA grade (p < 0.05). The MEWS in the non-survival group was significantly higher than that in the survival group. Different clinical outcomes were positively correlated with NYHA grade, MEWS, six-minute walking distance and left ventricular ejection fraction (r = 0.368, r = 0.471, r = 0.387, r = 0.423, p < 0.05), and negatively correlated with cTnI and BNP (r = –0.411, r = –0.425). The area under the ROC curve of the MEWS was 0.852, indicating higher accuracy. The optimal cut-off value, sensitivity and specificity of the MEWS for determining prognosis were 5.6, 0.854 and 0.797 points, respectively. Conclusion: The MEWS rose with increasing NYHA grade and reflected the severity of CHF in older patients, which has higher predictive value for long-term prognosis. Keywords: modified early warning score, older patient, chronic heart failure, long-term prognosis, NYHA functional classification Submitted 22/11/22, accepted 18/1/23 Published online 28/4/23 Cardiovasc J Afr 2024; 35: 40–43 www.cvja.co.za DOI: 10.5830/CVJA-2023-003 Chronic heart failure (CHF) is a comprehensive clinical cardiovascular disease with weakened myocardial contractility, ventricular filling and weakened pump function caused by changes in the myocardial structure and function due to cardiomyopathy, inflammation and long-term ventricular pressure, primarily manifested as fluid retention and dyspnoea.1,2 CHF frequently occurs in older people, and its incidence rate increases with age. The incidence rate of CHF in patients aged above 65 years is five to 10 times that in younger adults.3 It is reported that CHF patients have a poor long-term prognosis. Both death and rehospitalisation rates are at high levels, and the five-year mortality rate is up to 50%,4,5 seriously threatening the health of older people. Therefore, accurate diagnosis, prompt and effective treatment, and enhancement of long-term prognostic evaluation and prediction are crucial for the prevention of further worsening of CHF in older patients. Thyroid hormone level,6 plasma brain natriuretic peptide7 and chronic health score8 are associated with the prognosis of CHF, but they are inaccurate in a long-term prognostic evaluation. Therefore, it is of great importance to search for other indices for long-term prognostic evaluation of CHF patients. The modified early warning score (MEWS) is a fast, simple and scientific prediction tool for accurately identifying critically ill patients and assessing the risk of disease. It can timeously detect changes in the condition of patients through assessing the systolic blood pressure, heart rate, respiration, body temperature and consciousness of patients, thereby greatly improving the rescue success rate and prognosis.9 Currently, the MEWS has been widely applied in prediction and nursing interventions for severe asthenia,10 acute craniocerebral injury,11 stroke12 and trauma,13 achieving satisfactory effects. However, there are few reports about the MEWS in the long-term prognostic evaluation of older patients with CHF. In this study, the clinical data of 180 CHF patients admitted to our hospital from January 2016 to January 2018 were collected, their MEWS was analysed, and the value of the MEWS for assessing the severity of disease and long-term prognosis of CHF patients was explored, so as to provide references for effective prevention and control of CHF in the clinic. Methods A total of 180 CHF patients treated from January 2016 to January 2018 were selected as the subjects. Inclusion criteria were as follows: patients meeting the diagnostic criteria for CHF in the Chinese Guidelines for the Diagnosis and Treatment of Heart Failure 2014;14 those aged ≥ 60 years; and subjects with complete medical data. Exclusion criteria were as follows: patients with congenital heart disease or acute myocardial infarction; those Department of Cardiology, The First Affiliated Hospital of Shihezi University, Shihezi, Xinjiang Uygur Autonomous Region, China Yin Yin, PhD, czk71094@163.com Jie Chen, MD Shijiu Jiang, MD
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