Cardiology A

ADHERE Algorithm for Acute Decompensated Heart Failure

Stratifies mortality risk in hospitalised acute decompensated heart failure using 3 readily available parameters. Simple decision tree.

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. Apply clinical judgement and local guidance.

Fonarow GC et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293(5):572-580.

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.