Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

    Emergency Heart Failure Mortality Risk Grade (EHMRG)

    Estimates 7-day mortality of emergency CHF patients.


    This score is not intended for use in dialysis-dependent patients.
    When to Use
    Why Use

    The Emergency Heart Failure Mortality Risk Group (EHMRG) was designed to be used in the emergency department to predict 7-day mortality (recommending admission for those with high risk of mortality in 7 days).

    While most patients with heart failure are likely short of breath, feeling unwell, and amenable to admission, in the case they are not amenable, this tool may help educate and caution patients about their risk of going home.

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    Patients at high risk for death should be admitted to the hospital for diuresis, medication management and further evaluation of the cause of their decompensation.


    Addition of the assigned points, with several definitions, ranges, and limits:

    • Age is multiplied × 2.
    • Systolic blood pressure is subtracted (multiply × -1), with an upper limit of 160 mmHg.
    • Heart rate is limited to rates between 80-120.
    • Oxygen saturation is subtracted and doubled (multiply × -2), with an upper limit of 92%.
    • 'Troponin positive' is defined as greater than the upper limit of normal for one's laboratory.
    • An adjustment factor of 12 points was added to this score to make the median score approach zero.

    Facts & Figures

    • As stated above, the Emergency Heart Failure Mortality Risk Group (EHMRG) score cannot be used in patients on dialysis.
    • This score will be stronger with external validation, but the c-statistics were good for both the derivation and validation cohorts (0.803).
    • Mortality trends were similar in patients both admitted to the hospital and discharged from the ED, but with lower rates of death for those patients who were admitted.
    • The authors note that this interestingly does not include an ejection fraction in its calculation, and this may be a weakness of the study.
    • This was derived from a Canadian population, where EMS usage may be different, as well as use of metolazone and heart failure management strategies compared to other countries.
    Dr. Douglas Lee

    About the Creator

    Douglas S. Lee, MD, PhD is a senior scientist at the Institute for Clinical Evaluative Sciences, University of Toronto in Ontario, Canada, where he is also an associate professor of cardiology. He currently practices cardiology at the Peter Munk Cardiac Centre and University Health Network. Dr. Lee's research focuses include cardiovascular disorders, diagnostic testing/imaging, and health technology assessment.

    To view Dr. Douglas Lee's publications, visit PubMed