Comparison of Emergency Heart Failure Mortality Risk Grade and Ottawa Heart Failure Risk Score Scores in Predicting...

Patients discharged from the emergency department (ED) with acute decompensated heart failure (ADHF) face high mortality risks, which may render disposition decisions challenging. While clinical judgment is prominent, objective risk stratification tools such as the Emergency Heart Failure Mortality Risk Grade (EHMRG) and the Ottawa Heart Failure Risk Score (OHFRS) have been developed to aid physicians in these critical decisions.

This study compares the predictive performance of EHMRG and OHFRS scores for 30-day mortality in ADHF patients.

This single-center, prospective, observational study included patients presenting to a tertiary hospital ED with symptoms of dyspnea and diagnosed with ADHF according to the recent guidelines. EHMRG and OHFRS scores were calculated for all patients. The primary outcome was 30-day all-cause mortality. Secondary outcomes included hospital admission, intensive care unit (ICU) admissions, and ED revisits within 30 days. To evaluate the discriminative ability of the scores, the receiver operating characteristic (ROC) curve analysis were used.

Among 1,348 evaluated patients, 346 met the inclusion criteria. For predicting 30-day mortality, both scores demonstrated moderate accuracy (area under the curve [AUC]: EHMRG 0.774, OHFRS 0.706). For predicting hospital admission, the OHFRS score showed moderate accuracy (AUC: 0.742), while the EHMRG score showed low accuracy (AUC: 0.682). The OHFRS score was superior in predicting ICU admission with moderate accuracy. Neither score was predictive of ED revisits.

EHMRG and OHFRS scores can aid in predicting mortality, ICU admission, and safe discharge decisions in ADHF patients presenting to the ED. However, their utility in predicting ED revisits remains limited.