Emergency Heart Failure Mortality Risk Grade (EHMRG)
Clinical risk score predicting 7-day mortality in emergency department patients presenting with acute heart failure. Based on 8 variables assessed at ED arrival. Validated in the Ontario HF registry. Guides admission versus discharge decision-making.
Score interpretation
EHMRG 0 to 4 — under 1% 7-day mortality; early discharge may be appropriate
→ Early discharge with HF nurse or clinic follow-up within 7 days; optimise oral diuresis; daily weight monitoring; fluid restriction; patient education; GP notification; ensure guideline-directed medical therapy prescribed if HFrEF (ACEi or ARB or ARNI, beta-blocker, MRA, SGLT-2 inhibitor)
EHMRG 5 to 9 — intermediate 7-day risk; admission warranted
→ Admit to cardiology or general medicine; IV furosemide; haemodynamic monitoring; echocardiography if not recent; identify and treat precipitating cause (AF, ACS, infection, medication non-compliance); daily electrolytes and renal function; HF specialist review; escalate to HDU if deteriorating
EHMRG 10 or above — above 10% 7-day mortality; intensive monitoring required
→ HDU or ICU admission; IV vasodilators and inotropes for cardiogenic shock; NIV for pulmonary oedema; urgent ACS treatment if ACS-precipitated; nephrology for cardiorenal syndrome; palliative care discussion if end-stage trajectory; family meeting; escalation plan documented
Interpretation bands for the EHMRG. Apply clinical judgement and local guidance.
References
- Lee DS et al. Prediction of Heart Failure Mortality in Emergent Care: A Cohort Study. Ann Intern Med. 2012;156(11):767-775.
Related
Curated clinical cross-links plus same-class fallbacks.
- 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.