Lee reported the Emergency Heart Failure Mortality Risk Grade (EHMRG) score to evaluate a patient with heart failure in the Emergency Department. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of Toronto.
Patient selection: acute heart failure in the Emergency Department (ED)
Parameters at initial evaluation:
(1) age in years
(2) transported by emergency medical services (EMS)
(3) systolic blood pressure in mm Hg (SBP, maximum 160)
(4) heart rate in beats per minute (minimum 80, maximum 120)
(5) oxygen saturation in percent (maximum 92%)
(6) serum potassium in mmol/L
(7) serum creatinine in mg/dL
(8) serum troponin in µg/L
(9) active cancer
(10) metolazone (a diuretic) therapy at home
|
Parameter
|
Finding
|
Points
|
|
age in years
|
|
2 * (age)
|
|
transported by EMS
|
no
|
0
|
|
|
yes
|
60
|
|
systolic blood pressure
|
|
(-1) * (SBP)
|
|
heart rate
|
|
(heart rate)
|
|
oxygen saturation
|
|
(-2) * (saturation)
|
|
serum potassium
|
<= 3.9
|
5
|
|
|
4.0 to 4.5
|
0
|
|
|
>= 4.6
|
30
|
|
serum creatinine
|
|
20 * (creatinine)
|
|
troponin
|
<= ULN
|
0
|
|
|
> ULN
|
60
|
|
active cancer
|
no
|
0
|
|
|
yes
|
45
|
|
metolazone therapy
|
no
|
0
|
|
|
yes
|
60
|
where:
• All variables are required and should not be estimated.
score =
= SUM(points for all 10 parameters) + 12
Interpretation:
• The values varies with ae and other parameters.
|
Score
|
7-Day Mortality if Discharged from ED
|
7-Day Mortality if Hospitalized
|
|
<= -15.9
|
0.2%
|
0.4%
|
|
-15.8 to 17.9
|
0.25%
|
0.9%
|
|
18.0 to 56.5
|
1.5%
|
2.1%
|
|
56.6 to 89.3
|
1.7%
|
3.9%
|
|
>= 89.4
|
4.3%
|
8.9%
|
