Ottawa Heart Failure Risk Scale (OHFRS)
Use in patients presenting to the emergency department with acute dyspnea secondary to new-onset or chronic heart failure (HF), after initial intervention. Do not use prior to ED intervention. Do not use in patients who are hemodynamically unstable (see When to Use for full exclusion criteria).
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Interpreting medium risk scores can be the most difficult part of the OHFRS. Using scores >1 as an admission threshold increases sensitivity for serious adverse events (SAE) and increases admission rates, but a threshold of scores >2 leads to similar sensitivity to previous practice with a notable reduction in admission rates.
- Consider patient-specific factors to help determine disposition for patients with scores 1–2, e.g. access to medical care and timely follow-up, comorbidities, living conditions, frequency of HF exacerbations.
- As with all risk scores, use clinician judgment and shared decision-making model to ensure the patient is informed of the benefits and risks associated with their disposition regardless of whether they are admitted or discharged.
- Patients being discharged should receive thorough return precautions, as heart failure patients are at higher risk for severe complications than the general population.
- For patients with higher OHFRS (>1 or 2 depending on preference) or a concerning clinical presentation after initial intervention, consider admission for monitoring and further treatment.
- Patients with OHFRS <2, good response to ED intervention, and encouraging clinical presentation may be safe for discharge with close follow-up.
High or worsening score should trigger consideration of a higher level of care, including early involvement of intensivists, cardiologists, and other specialists.