Validation of MEESSI Score for Acute Heart Failure Risk Interview with:
Desiree Nadine Wussler MD
Cardiovascular Research Institute
Universitätsspital Basel What is the background for this study? What are the main findings? 

Response: Acute heart failure is the most common cause of hospitalization in patients 50 years or older with more than 2 millions of hospitalizations annually in both Europe and the United States.

As most patients with  acute heart failure present to the emergency department, an early risk stratification is of crucial importance in order to decide whether to hospitalize a patient or even treat him in an intensive care unit setting.

Recently, the MEESSI Acute heart failure risk score was developed to predict 30-day mortality in patients presenting with acute heart failure to emergency departments in Spain.  However, it was unknown whether it also performs well in other countries. When externally validating the MEESSI-Score in unselected AHF patients treated in another European country, we report the following major findings.

  1. After stratifying patients into the original MEESSI-AHF Score risk groups, a pronounced difference in 30-day mortality was found.
  2. The MEESSI-Score showed excellent discrimination for every applied model.
  3. In patients assigned to low and intermediate risk of 30-day mortality, the MEESSI-score showed near ideal calibration.
  4. After recalibration there was also a high concordance of the predicted 30-day mortality according to the MEESSI Score and the observed mortality in patients stratified to high and very high-risk. What should readers take away from your report?

Response: The MEESSI Score seems to be a highly promising tool for stratifying patients presenting to the emergency department with acute heart failure according to their risk. However, recalibration may be needed when introducing the score to new populations. Furthermore, recalibration could also be important when outcome frequencies change due to novel therapies and consecutive improved outcomes. To the best of our knowledge, except for the MEESSI-Score there is no other heart failure risk score which could be adapted to changed outcome frequencies that easily. What recommendations do you have for future research as a result of this work? 

Response: In my opinion the next step would be a clinical trial. In such a study, patients should be either randomized to a control group in which risk stratification and the following further treatment are left to the discretion of the attending physician or to the intervention group in which patients are stratified into different risk groups according to their MEESSI Score. In this setting the clinical implications and additional application areas of the MEESSI Score could be further characterized. 


Wussler D, Kozhuharov N, Sabti Z, Walter J, Strebel I, Scholl L, et al. External Validation of the MEESSI Acute Heart Failure Risk ScoreA Cohort Study. Ann Intern Med. [Epub ahead of print ] doi: 10.7326/M18-1967

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Last Updated on February 1, 2019 by Marie Benz MD FAAD