Romero-Correa, MiriamSalamanca-Bautista, PradoBilbao-Gonzalez, AmaiaQuiros-Lopez, RaulDolores Nieto-Martin, MariaLuisa Martin-Jimenez, MariaLuis Morales-Rull, JoseQuiles-Garcia, DoloresGomez-Gigirey, AdrianaFormiga, FrancescAramburu-Bodas, OscarLuis Arias-Jimenez, JoseEPICTER Investigators Grp2023-05-032023-05-032022-04-122055-5822http://hdl.handle.net/10668/21895Aims Estimating the prognosis in heart failure (HF) is important to decide when to refer to palliative care (PC). Our objective was to develop a tool to identify the probability of death within 6 months in patients admitted with acute HF.Methods and results A total of 2848 patients admitted with HF in 74 Spanish hospitals were prospectively included and followed for 6 months. Each factor independently associated with death in the derivation cohort (60% of the sample) was assigned a prognostic weight, and a risk score was calculated. The accuracy of the score was verified in the validation cohort. The characteristics of the population were as follows: advanced age (mean 78 years), equal representation of men and women, significant comorbidity, and predominance of HF with preserved ejection fraction. During follow-up, 753 patients (26%) died. Seven independent predictors of mortality were identified: age, chronic obstructive pulmonary disease, cognitive impairment, New York Heart Association class III-IV, chronic kidney disease, estimated survival of the patient less than 6 months, and acceptance of a palliative approach by the family or the patient. The area under the ROC curve for 6 month death was 0.74 for the derivation and 0.68 for the validation cohort. The model showed good calibration (Hosmer and Lemeshow test, P value 0.11). The 6 month death rates in the score groups ranged from 6% (low risk) to 54% (very high risk).Conclusions The EPICTER score, developed from a prospective and unselected cohort, is a bedside and easy-to-use tool that could help to identify high-risk patients requiring PC.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Advanced heart failurePalliative careRisk scorePrognosisPalliative careRisk stratificationSurprise questionTask-forceValidationModelsHospitalizationClassificationAssociationDerivationresearch articleopen access10.1002/ehf2.13924http://diposit.ub.edu/dspace/bitstream/2445/187813/1/724236.pdf782197000001