Emergency Heart Failure Mortality Risk Grade (EHMRG): explanation and clinical context The EHMRG is a point-based prognostic model designed to estimate short-term (7-day, and extended 30-day) mortality for patients who present to the emergency department with acute heart failure. It uses data available at ED presentation (age; mode of arrival by EMS; systolic blood pressure; heart rate; peripheral oxygen saturation; serum creatinine and potassium; troponin above the local upper limit of normal; active cancer; and outpatient metolazone use). Points are assigned per published coefficients (for example, age contributes roughly 2 × years; SBP contributes −1 × mmHg; O₂ saturation −2 × %; creatinine 20 × mg/dL; several categorical variables add +45 to +60 points) and a small constant adjustment is applied. The resulting numeric score stratifies patients into five short-term risk strata (very low → very high) using published cut-points; these strata were associated with progressively higher 7-day mortality in validation cohorts. The EHMRG has been externally validated and prospectively evaluated, outperformed clinician estimates of 7-day risk in validation studies, and can support—but not replace—clinical judgment about disposition (discharge vs short-stay vs admission).
Reference: Lee DS et al., prospective validation and derivation literature; external validation and coefficient table (published EHMRG coefficients and cut-points).
Lee DS et al., Prospective Validation of the Emergency Heart Failure Mortality Risk Grade for Acute Heart Failure (Circulation 2019) and validation/implementation summaries. For coefficient table and implementation details, see Sepehrvand et al. (external validation/refinement) and implementation summaries (EHMRG infographic / clinical tools).