cardiology emergency-medicine

ADHERE Algorithm for Acute Decompensated Heart Failure

Acute Decompensated Heart Failure National Registry (ADHERE) classification and regression tree. Predicts in-hospital mortality in patients admitted with ADHF using BUN, creatinine, and systolic BP.

Score interpretation

Low Risk (~2 % In-Hospital Mortality) 1

BUN < 43 mg/dL and SBP ≥ 115 mmHg: about 2.1 % in-hospital mortality in the ADHERE derivation cohort (Fonarow 2005).

→ Standard acute heart failure care; reassess if the clinical picture changes.

Intermediate Risk 3 (~5.5 % In-Hospital Mortality) 2

BUN < 43 mg/dL and SBP < 115 mmHg: about 5.5 % in-hospital mortality in the ADHERE derivation cohort (Fonarow 2005).

→ Closer monitoring of perfusion, renal function and decongestion.

Intermediate Risk 2 (~6.4 % In-Hospital Mortality) 3

BUN ≥ 43 mg/dL and SBP ≥ 115 mmHg: about 6.4 % in-hospital mortality in the ADHERE derivation cohort (Fonarow 2005).

→ Closer monitoring of renal function and decongestion.

Intermediate Risk 1 (~12.4 % In-Hospital Mortality) 4

BUN ≥ 43 mg/dL, SBP < 115 mmHg, creatinine < 2.75 mg/dL: about 12.4 % in-hospital mortality in the ADHERE derivation cohort (Fonarow 2005).

→ Consider a higher level of care; senior and cardiology review.

High Risk (~22 % In-Hospital Mortality) 5

BUN ≥ 43 mg/dL, SBP < 115 mmHg and creatinine ≥ 2.75 mg/dL: about 21.9 % in-hospital mortality in the ADHERE derivation cohort (Fonarow 2005).

→ Consider HDU / CCU care; urgent senior and cardiology review.

Interpretation bands for the ADHERE Algorithm. Apply clinical judgement and local guidance.

References

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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