Validation of the ADHERE model for risk stratification in patients with acute heart failure admitted to the critical care unit

Background

Decompensated heart failure (DHF) is responsible for high morbidity and mortality. Estimation of the mortality risk in patients admitted with DHF helps clinicians guiding care. Models for risk stratification of patients during admission for acute DHF are not well established. The Acute Decompensated Heart Failure National Registry (ADHERE) developed a tool for risk stratification for patients hospitalized with DHF.

Objective

To validate the ADHERE risk stratification model in a cohort of patients with DHF.

Design, setting and patients

A cohort study of 137 consecutive patients admitted to the coronary care unit with a primary diagnosis of DHF was conducted to determine the validity of the ADHERE risk stratification model. Demographics, clinical details, laboratory data and clinical outcome were recorded. The risk stratification model was applied and correlated with clinical outcomes.

Results

Baseline characteristics and main outcomes of this cohort were: 54% of patients were male, mean age was 76.52 ± 11.08 years and 79.6% of patients were considered NYHA class IV. The inhospital mortality was 9.2%. Admission ADHERE risk stratification was performed and we identified 70.67% of patients as low risk and 20.3% in the intermediate-risk group. No one was classified in the high-risk group. There was no correlation between the ADHERE risk stratification model and inhospital mortality.

Conclusions

In our small cohort of patients admitted due to DHF, the ADHERE risk stratification model did not accurately predict hospital mortality.