Risk stratification in acute heart failure (AHF) is essential for guiding clinical decisions in the emergency department (ED). The Multiple Estimation of Risk Based on the Emergency Department Spanish Score in AHF (MEESSI-AHF) is a validated tool for predicting 30-day mortality, though its performance across sexes has required further evaluation.

This observational registry analysis, published in Internal and Emergency Medicine, included 13,042 patients with acute heart failure from 56 Spanish emergency departments enrolled in the EAHFE registry between 2007 and 2022. Patients with available sex and MEESSI-AHF scores were categorized into four risk groups (low, intermediate, high, very high) and stratified by sex. The primary outcome was 30-day mortality, while secondary assessments examined ED and hospital clinical decisions relative to risk severity.

Overall, the MEESSI-AHF score demonstrated consistent risk stratification, with 30-day mortality rates of 2.9%, 9.6%, 18.2%, and 39.7% across increasing risk groups (c-statistic 0.78; p<0.001). Predictive performance was similar in men (c-statistic 0.77) and women (c-statistic 0.78), with no significant interaction by sex in categorical or continuous analyses (p>0.05).

Clinical decisions aligned with increasing risk severity. Hospital admission occurred in 76% of cases, extended ED observation (>24 hours) in 9% of discharged patients, and prolonged hospitalization (>7 days) in 47% of admitted patients. These decisions increased with higher risk categories (p<0.05), without differences between men and women within the same risk strata.
MEESSI-AHF provides comparable mortality risk estimation in men and women. Clinical decisions regarding hospitalization and observation were similar for men and women within the same risk levels.