Retrospective validation of acute heart failure risk stratification in the emergency department

Danika M. Nelson, Bo E. Madsen, Stephen L. Kopecky, Carole E. Jenson, Ann R. Loth, Aidan F. Mullan, Casey M. Clements, Grace Lin

Research output: Contribution to journalArticlepeer-review


Background: Heart Failure (HF) is a primary diagnosis for hospital admission from the Emergency Department (ED), although not all patients require hospitalization. The Emergency Heart Failure Mortality Risk Grade (EHMRG) estimates 7-day mortality in patients with acute HF in ED settings, but further validation is needed in the United States (US). Objectives: To validate EHMRG scores by risk-stratifying patients with acute HF in a large tertiary healthcare center in the US and analyze outcome measures to determine if EHMRG risk scores safely identify low-risk groups that may be discharged or managed in ED observation units (EDOUs). Methods: A retrospective cohort analysis of 304 patients with acute HF presenting to an ED at a large, tertiary healthcare center was completed. EHMRG scores were calculated to stratify patients according to published thresholds. Mortality and major adverse cardiac event (MACE) rates were analyzed. Results: No deaths occurred in very low and low-risk EHMRG groups at 7 days post discharge. 30-day mortality was significantly less in the lower risk groups (3.1%) when compared to all other patients (11.1%). MACE rates at 30 days in the very low risk group (15%) were significantly less when compared to all other patients (31.3%). Hospitalizations occurred in 23.4% of patients in lower risk groups. Conclusions: ED risk stratification with EHMRG differentiates high-risk patients requiring hospitalization from lower risk patients who can be safely managed in alternative settings with good outcomes. Data supports improved pathways for patients with acute HF during a time of high hospital volumes.

Original languageEnglish (US)
Pages (from-to)31-40
Number of pages10
JournalHeart and Lung
StatePublished - Jan 1 2023


  • Acute heart failure
  • Emergency department (ED)
  • Emergency department observation unit (EDOU)
  • Emergency heart failure mortality risk grade (EHMRG)
  • Mortality
  • Risk stratification

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine


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