Acute Decompensated Heart Failure National Registry (ADHERE)

Stratifies mortality risk in patients with heart failure according based on three clinical variables obtained on hospital admission.

Refer to the text below the tool for more information about the ADHERE algorithm.


The ADHERE Algorithm based on the Acute Decompensated Heart Failure National Registry is a risk stratification model validated for predicting in-hospital mortality due to ADHF.

The algorithm was developed and validated on a registry of 65,275 patients from several US clinical centers and features a tree model with three variables: blood urea nitrogen (BUN), systolic blood pressure (SBP) and serum creatinine.


The ADHERE model identifies three risk groups, depending on the values of the clinical variables analysed:

ADHF risk group & mortality risk Clinical variables
Low Mortality Risk from ADHF: 2.1-2.3% BUN < 43 mg/dL (15.35 mmol/L)
SBP > 115 mmHg
Intermediate Mortality Risk from ADHF: 5.5-13.2% BUN ≥ 43 mg/dL (15.35 mmol/L)
SBP > 115 mmHg
and
Creatinine < 2.75 mg/dl (243.1 mmol/L)
High Mortality Risk from ADHF: 19.8-21.9% BUN ≥ 43 mg/dL (15.35 mmol/L)
SBP < 115 mmHg
Creatinine ≥ 2.75 mg/dl (243.1 mmol/L)

1Blood Urea Nitrogen (BUN) ≥ 43 mg/dL (15.35 mmol/L)
2Systolic Blood Pressure (SBP) < 115 mmHg
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ADHERE Risk Score Explained

The ADHERE Algorithm based on the Acute Decompensated Heart Failure National Registry is a risk stratification model validated for predicting in-hospital mortality due to ADHF.

The algorithm was developed and validated on a registry of 65,275 patients from 263 US clinical centers, totalling outcomes from 33,046 hospitalization episodes (original study) and 32,339 hospitalizations (validation study). Patients had a mean age of 72.5 years and in terms of gender, 52% were female and 48% male.

It features a tree model with three variables which rely on laboratory data obtained on hospital admission: blood urea nitrogen (BUN), systolic blood pressure (SBP) and serum creatinine.

The ADHERE model identifies three risk groups with mortality risks ranging from 2.1% to 21.9%, depending on the values of the clinical variables analysed:

ADHF risk group & mortality risk Clinical variables
Low Mortality Risk from ADHF: 2.1-2.3% BUN < 43 mg/dL (15.35 mmol/L)
SBP > 115 mmHg
Intermediate Mortality Risk from ADHF: 5.5-13.2% BUN ≥ 43 mg/dL (15.35 mmol/L)
SBP > 115 mmHg
and
Creatinine < 2.75 mg/dl (243.1 mmol/L)
High Mortality Risk from ADHF: 19.8-21.9% BUN ≥ 43 mg/dL (15.35 mmol/L)
SBP < 115 mmHg
Creatinine ≥ 2.75 mg/dl (243.1 mmol/L)

One criticism of the model relates to the fact that it does not allow for a more precise description of individual risk.

Similarly to the ADHERE algorithm, the MAGGIC risk score focuses on predicting life expectancy in patients with heart failure.

 

References

Original reference

Fonarow GC, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005; 293(5):572-80.

Validation

Rey HCV, et al. Validation of the ADHERE model for risk stratification in patients with acute heart failure admitted to the critical care unit. Critical Care20059(Suppl 2):P35.

Other references

Passantino A, Monitillo F, Iacoviello M, Scrutinio D. Predicting mortality in patients with acute heart failure: Role of risk scores. World J Cardiol. 2015; 7(12):902-11.


Specialty: Cardiology

System: Cardiovascular

Objective: Risk Stratification

Year Of Study: 2005

Abbreviation: ADHERE

Article By: Denise Nedea

Published On: August 28, 2020

Last Checked: August 28, 2020

Next Review: August 28, 2025