Estimates 7-day mortality of emergency HF patients.
Why Use
While most patients with heart failure are likely short of breath, feeling unwell, and amenable to admission, in the case they are not amenable, this tool may help educate and caution patients about their risk of going home.
When to Use
The Emergency Heart Failure Mortality Risk Group (EHMRG) was designed to be used in the emergency department to predict 7-day mortality (recommending admission for those with high risk of mortality in 7 days).
Formula
The Emergency Heart Failure Mortality Risk Grade (EHMRG) Score is determined by the addition of the multiplicative component: Variable Multiplicative Component Age, y 2 × age Transported by EMS No 0 Yes 60 Systolic blood pressure, mmHg (Initial/triage SBP, maximum of 160 mmHg 1 ) -1 × SBP Heart rate, beats/min (Initial/triage heart rate, minimum of 80 beats/min and maximum of 120 beats/min 1 ) 1 × heart rate Oxygen saturation, % (Lowest initial/triage oxygen saturation, maximum of 92% 1 ) -2 × oxygen saturation Creatinine, mg/dL 20 × creatinine Potassium ≤3.9 mmol/L 5 4.0 to 4.5 mmol/L 0 ≥4.6 mmol/L 30 Troponin > ULN No 0 Yes 60 Active cancer No 0 Yes 45 Metolazone use at home No 0 Yes 60 Adjustment factor 2 12 1. Adjustment factor of 12 added to allow for an approximate 0 median score. 2. Any values of the variable beyond these limits are treated as if they contribute no additional information or effect on the outcome. The Emergency Heart Failure Mortality Risk Group (EHMRG) score cannot be used in patients on dialysis.
Advice
Patients at high risk for death should be admitted to the hospital for diuresis, medication management, and further evaluation of the cause of their decompensation.
More Information
Interpretation: EHMRG Score Risk Group 7-day Mortality Rate* ≤-49.1 1 0.5 -49.0 to -15.9 2 0.3 -15.8 to 17.9 3 0.7 18.0 to 56.5 4 2.1 56.6 to 89.3 5a 3.3 ≥89.4 5b 8.5 * Values from Lee et. al. (2012) validation datasets are used in this calculator.