{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T19:21:08Z","timestamp":1775157668378,"version":"3.50.1"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":1474,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T00:00:00Z","timestamp":1637539200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"The European General Practice Research Network","award":["HP\/2015.036"],"award-info":[{"award-number":["HP\/2015.036"]}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI14\/00583"],"award-info":[{"award-number":["PI14\/00583"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI14\/00583"],"award-info":[{"award-number":["PI14\/00583"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Because evidence regarding risk stratification predicting prognosis of patients with heart failure (HF) decompensation attended in primary care is lacking, we developed and externally validated a model to forecast death\/hospitalization during the first 30 days after an episode of decompensation. The predictive model is based on variables easily obtained in primary care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>HEFESTOS is a multinational study consisting of a derivation cohort of HF patients recruited in 14 primary healthcare centres in Barcelona and a validation cohort from primary healthcare in 9 other European countries. The derivation and validation cohorts included 561 and 250 patients, respectively. Percentages of women in the derivation and validation cohorts were 56.3% and 47.6% (P = 0.026), respectively. Mean age was 82.2 years (SD 8.03) in the derivation cohort, and 79.3 years (SD 10.3) in the validation one (P = 0.001). HF with preserved ejection fraction represented 72.1% in the derivation cohort and 58.8% in the validation one (P = 0.004). Mortality\/hospitalization during the first 30 days after a decompensation episode was 30.5% and 26% (P = 0.225) for the derivation and validation cohorts, respectively. Multivariable logistic regression models were performed to develop a score of risk. The identified predictors were worsening of dyspnoea [odds ratio (OR): 2.5; P = 0.001], orthopnoea (OR: 2.16; P = 0.01), paroxysmal nocturnal dyspnoea (OR: 2.25; P = 0.01), crackles (OR: 2.35; P = 0.01), New York Heart Association functional class III\/IV (OR: 2.11; P = 0.001), oxygen saturation \u2264 90% (OR: 4.98; P &amp;lt; 0.001), heart rate &amp;gt; 100 b.p.m. (OR: 2.72; P = 0.002), and previous hospitalization due to HF (OR: 2.45; P &amp;lt; 0.001). The model showed an area under the curve (AUC) of 0.807, 95% confidence interval (CI): [0.770; 0.845] in the derivation cohort and AUC 0.73, 95% CI: [0.660; 0.808] in the validation one. No significant differences between both cohorts were observed (P = 0.08). Regarding probability of hospitalization\/death, three risk groups were defined: low &amp;lt;5%, medium 5\u201320%, and high &amp;gt;20%. Outcome incidence was 2.7% for the low-risk group, 12.8% for medium risk, and 46.2% for high risk in the derivation cohort, and 9.1%, 12.9%, and 39.6% in the validation one.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The HEFESTOS score, based on variables easily accessible in a community setting and validated in an external European cohort, properly predicted the risk of death\/hospitalization during the first 30 days after an HF decompensation episode.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13707","type":"journal-article","created":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T22:31:25Z","timestamp":1637620285000},"page":"606-613","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Risk Stratification in Heart Failure Decompensation in the Community: HEFESTOS Score"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4225-8504","authenticated-orcid":false,"given":"Jos\u00e9-Mar\u00eda","family":"Verdu-Rotellar","sequence":"first","affiliation":[{"name":"Gerencia Territorial de Barcelona, Institut Catal\u00e0 de la Salut , Barcelona ,","place":["Spain"]},{"name":"Unitat de Suport a la Recerca de Barcelona, Fundaci\u00f3 Institut Universitari per a la recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) , Barcelona ,","place":["Spain"]},{"name":"School of Medicine, Universitat Aut\u00f2noma de Barcelona , Bellaterra ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"Abellana","sequence":"additional","affiliation":[{"name":"Departament de Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helene","family":"Vaillant-Roussel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, UPU ACCePPT, Department of General Practice, CHU, Direction de La Recherche Clinique et de l'Innovation, Clermont Auvergne University , Clermont-Ferrand ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lea","family":"Gril Jevsek","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Maribor , Maribor ,","place":["Slovenia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radost","family":"Assenova","sequence":"additional","affiliation":[{"name":"Department of Urology and General Medicine, Faculty of Medicine, Medical University of Plovdiv , Plovdiv ,","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Djurdjica","family":"Kasuba Lazic","sequence":"additional","affiliation":[{"name":"Department of Family Medicine \u201cAndrija Stampar\u201d School of Public Health, School of Medicine University of Zagreb , Zagreb ,","place":["Croatia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Torsza","sequence":"additional","affiliation":[{"name":"Semmelweis University , Budapest ,","place":["Hungary"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liam George","family":"Glynn","sequence":"additional","affiliation":[{"name":"Health Research Institute and Graduate Entry Medical School, University of Limerick , Limerick ,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidrun","family":"Lingner","sequence":"additional","affiliation":[{"name":"Hannover Medical School-Center for Public Health and Healthcare , Hannover ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacopo","family":"Demurtas","sequence":"additional","affiliation":[{"name":"Primary Care Department, Azienda Usl Toscana Sud Est , Grosseto ,","place":["Italy"]},{"name":"Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia , Modena ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans","family":"Thulesius","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Lund University , Lund ,","place":["Sweden"]},{"name":"Department of Medicine and Optometry, Linnaeus University , V\u00e4xj\u00f6 ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miguel Angel","family":"Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Gerencia Territorial de Barcelona, Institut Catal\u00e0 de la Salut , Barcelona ,","place":["Spain"]},{"name":"Unitat de Suport a la Recerca de Barcelona, Fundaci\u00f3 Institut Universitari per a la recerca a l'Atenci\u00f3 Prim\u00e0ria de Salut Jordi Gol i Gurina (IDIAPJGol) , Barcelona ,","place":["Spain"]},{"name":"School of Medicine, Universitat Aut\u00f2noma de Barcelona , Bellaterra ,","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"HEFESTOS group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,11,22]]},"reference":[{"key":"2026012114183324500_ehf213707-bib-0001","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0172745","article-title":"Real world heart failure epidemiology and outcome: a population-based analysis of 88,195 patients","volume":"12","author":"Farr\u00e9","year":"2017","journal-title":"PLoS ONE"},{"key":"2026012114183324500_ehf213707-bib-0002","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1161\/HHF.0b013e318291329a","article-title":"Forecasting the 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