Authors : Dr. Faisal; Dr. Faiza Jamil

Volume/Issue : Volume 11 - 2026, Issue 4 - April

Google Scholar : https://tinyurl.com/374jrur5

DOI : https://doi.org/10.38124/ijisrt/26apr1042

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : This study evaluates the efficacy of a simplified risk score derived from the Acute Decompensated Heart Failure National Registry (ADHERE) in predicting in-hospital mortality among patients with acute heart failure and reduced ejection fraction. The model utilizes readily available clinical parameters to enable rapid bedside risk stratification and support clinical decision-making in acute care settings. Given the heterogeneity in patient presentation and outcomes, reliable risk prediction tools are essential for optimizing management and resource allocation. The discriminatory power and calibration of the ADHERE risk model were assessed in a specific patient cohort and compared with alternative prognostic scores. Particular attention was given to the contribution of individual components, including admission B-type natriuretic peptide (BNP), and the clinical relevance of common practices such as in-hospital observation on oral diuretics. Findings highlight the utility of simplified risk models while underscoring the need for external validation across diverse populations. Emerging strategies, including multimarker approaches integrating natriuretic peptides, cardiac troponins, and inflammatory markers, may enhance predictive accuracy. Furthermore, incorporation of echocardiographic parameters and advanced analytical methods, such as machine learning, offers potential for improving individualized risk assessment. Despite promising advancements, challenges remain in standardizing biomarker use and translating complex models into routine clinical practice. Overall, this study supports the continued refinement of risk stratification tools to improve prognostication and guide personalized management in heart failure.

References :

1. Arruda, S., Miranda, P., Araújo, T., Teixeira, K., Souza, C., Veizaga, R., Souza, G., & Costa, J. (2009). Unstable angina and non-ST-segment elevation myocardial infarction: an analysis by TIMI score. Critical Care, 13. https://doi.org/10.1186/cc7838
2. Bernardes, D. de S., Santos, M. S., Mantovani, V. M., Almeida, O. P. de, Goldraich, L. A., Clausell, N., & Rabelo, E. R. (2023). Uso do Modelo de Risco ADHERE como Preditor de Piora Intra-Hospitalar de Insuficiência Cardíaca em uma Coorte. Arquivos Brasileiros de Cardiologia, 120(8). https://doi.org/10.36660/abc.20220584
3. Bittencourt, M., Rocha, R., Rey, H., Rangel, F., Oliveira, F., Salgado, C., García, M., & Esporcatte, R. (2005). Prognostic value of D-dimer in acute heart failure. Critical Care, 9. https://doi.org/10.1186/cc3573
4. Cooper, L. B., DeVore, A. D., Cowger, J., Pinney, S., Baran, D. A., DeWald, T. A., Burt, T., Pietzsch, J. B., Walton, A., Aaronson, K. D., & Shah, P. (2023). Patients hospitalized with acute heart failure, worsening renal function, and persistent congestion are at high risk for adverse outcomes despite current medical therapy. Clinical Cardiology, 46(10), 1163. https://doi.org/10.1002/clc.24080
5. Fonarow, G. C., Adams, K. F., Abraham, W. T., Yancy, C. W., & Boscardin, W. J. (2005a). Risk Stratification for In-Hospital Mortality in Acutely Decompensated Heart Failure<SUBTITLE>Classification and Regression Tree Analysis</SUBTITLE>. JAMA, 293(5), 572. https://doi.org/10.1001/jama.293.5.572
6. Fonarow, G. C., Adams, K. F., Abraham, W. T., Yancy, C. W., & Boscardin, W. J. (2005b). Risk stratification for in-hospital mortality in acutely decompensated heart failure. Classification and regression tree analysis. ACC Current Journal Review, 14(4), 34. https://doi.org/10.1016/j.accreview.2005.02.073
7. Fortich, F., Ochoa-Morón, A. D., Cruz, B. B. de L., Rentería-Roa, J. A., Orego, D. H., Gándara, J., Muñoz-Ortiz, E., Hernández, G., & Sánchez, J. M. S. (2019). Factores de riesgo para mortalidad en falla cardiaca aguda. Análisis de árbol de regresión y clasificación. Revista Colombiana de Cardiología, 27(1), 20. https://doi.org/10.1016/j.rccar.2019.03.006
8. Liu, P., Qu, F., Ma, C., & Ren, Y. (2025). Association of longitudinal blood urea nitrogen trajectory with in-hospital and 28-day mortality in acute heart failure with cardiorenal syndrome. European Journal of Medical Research, 30(1). https://doi.org/10.1186/s40001-025-03232-9
9. Museedi, A., Alshami, A., Douedi, S., Ajam, F., & Varón, J. (2020). Predictability of Inpatient Mortality of Different Comorbidities in Both Types of Acute Decompensated Heart Failure: Analysis of National Inpatient Sample. Cardiology Research, 12(1), 29. https://doi.org/10.14740/cr1186
10. Nakano, H., Omote, K., Nagai, T., Nakai, M., Nishimura, K., Honda, Y., Honda, S., Iwakami, N., Sugano, Y., Asaumi, Y., Aiba, T., Noguchi, T., Kusano, K., Yokoyama, H., Yasuda, S., Ogawa, H., Chikamori, T., & Anzai, T. (2019). Comparison of Mortality Prediction Models on Long-Term Mortality in Hospitalized Patients With Acute Heart Failure ― The Importance of Accounting for Nutritional Status ―. Circulation Journal, 83(3), 614. https://doi.org/10.1253/circj.cj-18-1243
11. Novack, V., Pencina, M., Zahger, D., Fuchs, L., Nevzorov, R., Jotkowitz, A., & Porath, A. (2010). Routine Laboratory Results and Thirty Day and One-Year Mortality Risk Following Hospitalization with Acute Decompensated Heart Failure. PLoS ONE, 5(8). https://doi.org/10.1371/journal.pone.0012184
12. Rehman, M. U., Ahmed, I., Alam, F., Hussain, Z., Mustafa, A., Masoom, M., Jafar, M. A., & Zahra, H. E. (2023). Association of Hypoalbuminemia within Hospital Mortality in Patients with Acute Decompensated Heart Failure. Journal of Health and Rehabilitation Research, 3(2), 1110. https://doi.org/10.61919/jhrr.v3i2.297
13. Sakr, A. R. M., Gomaa, G. F., Wasif, S. M. E., & Eladawy, A. H. H. (2023). The prognostic role of urea-to-creatinine ratio in patients with acute heart failure syndrome: a case–control study. The Egyptian Heart Journal, 75(1), 78. https://doi.org/10.1186/s43044-023-00404-y
14. Solela, G., & Yimer, Y. S. (2024). Clinical characteristics, treatment patterns, and outcomes of hospitalized patients with acute heart failure in central Ethiopia: a retrospective observational study. BMC Cardiovascular Disorders, 24(1). https://doi.org/10.1186/s12872-024-03905-z
15. Takaya, Y., Yoshihara, F., Yokoyama, H., Kanzaki, H., Kitakaze, M., Goto, Y., Anzai, T., Yasuda, S., Ogawa, H., & Kawano, Y. (2015). Risk Stratification of Acute Kidney Injury Using the Blood Urea Nitrogen/Creatinine Ratio in Patients With Acute Decompensated Heart Failure. Circulation Journal, 79(7), 1520. https://doi.org/10.1253/circj.cj-14-1360
16. Villacorta, H. (2023). Piora Hospitalar da Insuficiência Cardíaca: Podemos Prevê-la na Admissão? Arquivos Brasileiros de Cardiologia, 120(8). https://doi.org/10.36660/abc.20230525
17. Wehbe, R. M., Khan, S. S., Shah, S. J., & Ahmad, F. S. (2020). Predicting High-Risk Patients and High-Risk Outcomes in Heart Failure [Review of Predicting High-Risk Patients and High-Risk Outcomes in Heart Failure]. Heart Failure Clinics, 16(4), 387. Elsevier BV. https://doi.org/10.1016/j.hfc.2020.05.002
18. Win, S., Hussain, I., Hebl, V. B., Dunlay, S. M., & Redfield, M. M. (2017). Inpatient Mortality Risk Scores and Postdischarge Events in Hospitalized Heart Failure Patients. Circulation Heart Failure, 10(7). https://doi.org/10.1161/circheartfailure.117.003926
19. Zhao, H.-L., Gao, X., Liu, Y.-H., Li, S.-L., Zhang, Q., Shan, W., Zheng, Q., Zhou, J., Liu, Y.-Z., Liu, L., Guo, N., Hong-sen, T., Wei, Q., Hu, X.-T., Cui, Y.-K., Geng, X., Wang, Q., & Cui, W. (2022). Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovascular Disorders, 22(1). https://doi.org/10.1186/s12872-022-02743-1