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
In-hospital mortality ~2.1%. (BUN normal, SBP maintained)
→ Standard HF treatment. Diuretics, ACEi/ARB/ARNI, beta-blocker optimisation.
In-hospital mortality ~5–7%. Renal or haemodynamic compromise.
→ Intensive monitoring. Consider IV diuretics, inotropes if haemodynamically compromised. Cardiology review.
In-hospital mortality ~20%+. Significant haemodynamic compromise and/or renal failure.
→ ICU/HDU admission. Haemodynamic monitoring. Consider mechanical support. Urgent cardiology/cardiac surgery review.
Interpretation bands for the ADHERE. Apply clinical judgement and local guidance.
References
- 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.
Related
Curated clinical cross-links plus same-class fallbacks.
- TIMI Risk Index for STEMI · Risk Stratification
- LACE Index for Readmission Risk · Risk Stratification
- Charlson Comorbidity Index (CCI) — Detailed · Risk Stratification
- GI-BLEED Score for Upper GI Bleeding · Risk Stratification
- HCT-CI — Haematopoietic Cell Transplant Comorbidity Index · Risk Stratification
- San Francisco Syncope Rule (SFSR) · Risk Stratification
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.