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Acute Decompensated Heart Failure National Registry (ADHERE) Algorithm

Calculators  Cardiovascular
The Acute Decompensated Heart Failure National Registry (ADHERE) Algorithm estimates the in-hospital mortality in admitted patients with acute decompensated heart failure.
Blood urea nitrogen (BUN) ≥ 43 mg/dL (15.35 mmol/L)
No 0
Yes 1
Systolic blood pressure (sBP) < 115 mmHg
No 0
Yes 1
Creatinine levels ≥2.75 mg/dl (243.1 mmol/L)
No 0
Yes 1
Result:

Background

Measured Factor
Mortality risk from acute decompensated heart failure
Measured Factor Disease
  • Acute decompensated heart failure
Measured Factor Detail
The ADHERE Algorithm estimates the in-hospital mortality in admitted patients with acute decompensated heart failure. This algorithm uses Blood urea nitrogen (BUN), Systolic blood pressure (SBP), and creatinine levels to classify patients as low level risk (2.1-2.3% mortality rate), intermediate level risk (5.5-13.2% mortality rate), and high level risk (19.8-21.9% mortality rate).
Speciality
Cardiologist
Body System
Cardiovascular
Measured Factor High Impact
  • High mortality risk from acute decompensated heart failure

Result Interpretation

Ranges Ranges
  • Critical High: High level risk (19.8-21.9% mortality rate from acute decompensated heart failure)
  • Normal: Low level risk (2.1-2.3% mortality rate from acute decompensated heart failure)
  • Normal Adult Male: Low level risk (2.1-2.3% mortality rate from acute decompensated heart failure)
  • Normal Adult Female: Low level risk (2.1-2.3% mortality rate from acute decompensated heart failure)
  • Normal Geriatric Male: Low level risk (2.1-2.3% mortality rate from acute decompensated heart failure)
  • Normal Geriatric Female: Low level risk (2.1-2.3% mortality rate from acute decompensated heart failure)
Result High Conditions
  • Acute decompensated heart failure
Test Limitations
The ADHERE Algorithm does not predict intermediate and long-term mortality risks. Moreover, this algorithm enhances and not replaces physician assessment, because the patient's actual risk may be influenced by other factors not included in this algorithm such as age and heart rate.
References: 1

Studies

Study Validation 1
This study compared the performance of 7 models that predict inpatient mortality in patients hospitalized with acute decompensated heart failure. The models were ADHERE (Acute Decompensated Heart Failure National Registry), EFFECT (Enhanced Feedback for Effective Cardiac Treatment), GWTG-HF registry (Get With the Guidelines-Heart Failure) by Eapen or Peterson, Premier, Premier+, and LAPS2 (Laboratory-Based Acute Physiology Score). Data from 13,163 patients were used with in-hospital mortality risk of 4.3%. In-hospital mortality risks were Premier+ (0.8%-23.1%), LAPS2 (0.7%-19.0%), ADHERE (1.2%-17.4%), EFFECT (1.0%-12.8%), GWTG-Eapen (1.2%-13.8%), and GWTG-Peterson (1.1%-12.8%). The LAPS2 and Premier models had C statistics ranging from 0.76 to 0.80; whereas, the clinical models had C statistics near 0.70. Since all models exhibited similar performance with C statistics ranging from 0.70 to 0.80, the study concluded that the decision to use which model depended on practical concerns and intended use.
References: 2
Study Validation 2
This single-center, community-based, retrospective study of 6203 heart failure hospitalizations in 3745 patients study evaluated the ability of the Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines (GWTG) models to predict in-hospital mortality risk and early postdischarge mortality risk. There were 176 (3.0%) and 399 (6.7%), 869 (14.7%), and 1272 (21.5%) deaths in-hospital and at 30, 90, and 180 days postdischarge, respectively. Both the ADHERE (C statistic 0.66 and 0.67, 0.64, and 0.64) and GWTG (C statistic 0.74 and 0.73, 0.71, and 0.70) heart failure risk scores were similarly predictive of in-hospital and 30-, 90-, and 180-day postdischarge mortality. Hospitalizations characterized as lowest risk by the ADHERE (180-day mortality 16.2%) or GWTG score (180-day mortality 8.0%) had substantially lower mortality (P<0.0001). The study concluded that ADHERE and GWTG scores may classify both in-hospital mortality risk and early postdischarge mortality risk in hospitalized heart failure patients.
References: 3
Study Validation 3
The mortality risk for heart failure may differ between men and women. This evaluated examined the ability of the Acute Decompensated Heart Failure National Registry (ADHERE) Algorithm to predict in-hospital mortality in women versus men. The Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM) database with 10,984 patients was used. There were 5,736 (52.2%) women participated in the study. In-hospital mortality risk was similar between men and women (p = 0.727). Blood urea nitrogen, systolic blood pressure, and serum creatinine were significant different in women versus men (p < 0.0002). However, (ADHERE) Algorithm was effective at predicting in-hospital mortality risk regardless of gender.
References: 4

Authors

Gregg C. Fonarow
MD, 1987
His research focuses on acute and chronic heart failure, preventative cardiology, quality of care, outcomes, and implementing treatment systems to improve clinical outcome, Dr. Gregg C. Fonarow is a professor of Cardiovascular Medicine and Science at University of California, Los Angeles (UCLA). He serves as the director of the Ahmanson-UCLA Cardiomyopathy Center, co-director of UCLA’s Preventative Cardiology Program, and clinical co-chief of Cardiology in the UCLA Division of Cardiology
Research Interests: https://people.healthsciences.ucla.edu/institution/personnel?personnel_id=8623

References

  1. Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ; ADHERE Scientific Advisory Committee, Study Group, and Investigators. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005 Feb 2;293(5):572-80.
  2. Lagu T, Pekow PS, Shieh MS, Stefan M, Pack QR, Kashef MA. Validation and Comparison of Seven Mortality Prediction Models for Hospitalized Patients With Acute Decompensated Heart Failure. Circ Heart Fail. 2016 Aug;9(8).
  3. Win S, Hussain I, Hebl VB, Dunlay SM, Redfield MM. Inpatient Mortality Risk Scores and Postdischarge Events in Hospitalized Heart Failure Patients: A Community-Based Study. Circ Heart Fail. 2017 Jul;10(7).
  4. Diercks DB, Fonarow GC, Kirk JD, Emerman CL, Hollander JE, Weber JE. Risk stratification in women enrolled in the Acute Decompensated Heart Failure National Registry Emergency Module (ADHERE-EM). Acad Emerg Med. 2008 Feb;15(2):151-8.