Hubungan Skor Emergency Heart Failure Mortality Risk Grade (EHMRG) dengan Kejadian Kardiovaskular Mayor pada Pasien Gagal Jantung Akut di Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Introduction: Heart failure (HF) is a health problem with a prevalence of 64 million people worldwide. HF is associated with high mortality and morbidity rates, poor quality of life, and places a great burden on the health care system. Acute Heart Failure (AHF) is a condition that requires immediate treatment and has a high risk of mortality and Major Cardiovascular Events (MACE). The Emergency Heart Failure Mortality Risk Grade (EHMRG) Score has been developed as a mortality risk prediction tool in emergency heart failure patients in emergency health care units. The EHMRG score was initially used as a risk stratification tool and to assess the estimated 7-day mortality risk, but several other studies have shown that this score can also predict MACE in the AHF population. However, the relationship between the EHMRG Score and MACE in AHF patients in Indonesia still needs to be studied further. Objective: The objective of the study was to assess the relationship between EHMRG Score and MACE in AHF patients at Haji Adam Malik General Hospital, Medan. Method: This study is a retrospective observational cohort design with a sample of AHF patients at H. Adam Malik General Hospital Medan from January 2024 to March 2025. Data were collected and analyzed on patient characteristics, EHMRG score assessment, and observation of MACE within 7 days and during treatment. Statistical analysis was performed using ROC curves and multivariate analysis. Data analysis was performed using SPSS version 24.0. Results: The total number of study subjects was 337 people. The average age was 55.26±13.139 years. Most of the subjects were male, 223 patients (66.2%). The shortest length of treatment was 1 day and the longest was 47 days, with a median of 5 days. The most common characteristics of AHF were ADHF with 223 patients (66.2%). The most common etiology of AHF was infection with 161 patients (47.8%). Pneumonia and RHD were the most common causes of infection with 91 (56.5%) and 29 (18.1%) patients. A total of 172 (51%) patients with HFrEF. During treatment, the most common MACE was mortality with 69 (20.5%) samples. MACE within 7 days was 83 patients (24.6%), and the incidence of mortality within 7 days was 43 patients (12.8%). Age, Systolic Blood Pressure, Heart Rate, Oxygen Saturation and Troponin level have a significant influence on 7-day MACE with a p-value <0.05. The results showed that the EHMRG score has a significant predictive value for the occurrence of MACE within 7 days with an AUC value of 0.802 and a p-value of 0.000, Sensitivity 68.7% and Specificity 77.6%. Conclusion: There is a significant relationship between EHMRG score with MACE, indicating that EHMRG score can be used as a predictive tool for MACE risk in AHF patients. The use of this score can assist in clinical decision making and improve patient management.