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    Ottawa Heart Failure Risk Scale (OHFRS)

    Identifies ED patients with heart failure at high risk for serious adverse events.

    INSTRUCTIONS

    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).

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients presenting to the ED with HF exacerbation who have responded to treatment.
    • Do not use if:
      • Resting O₂ sat <85% on room air on normal home O₂ for >20 minutes.
      • Heart rate >120 on arrival.
      • Systolic BP <85 mmHg on arrival.
      • Confusion, disorientation, or dementia.
      • Ischemic chest pain requiring nitrates on arrival.
      • ST segment elevation on EKG.
      • Death expected within weeks from chronic illness.
      • Nursing home or chronic care facility resident.
      • On chronic hemodialysis.
    • The Ottawa Heart Failure Risk Scale (OHFRS) identifies ED patients with HF at high risk for serious adverse events (SAE), including death, MI, need for ICU/intubation.
    • Best suited for ED patients presenting with HF exacerbation who have responded to treatment in the ED.
    • Not intended to be used in determining disposition until after ED intervention (in the study, OHFRS was assessed 2-8 hours after initial ED treatment).
    • Can be used even if NT-proBNP is unavailable without sacrificing accuracy significantly.
    • Derivation study was conducted in Canada, where only 38% of patients presenting to EDs with acute HF are admitted, compared with 80% in the US (citation). Regional practice patterns should be considered in applying this score.
    • Patients presenting with acute HF or exacerbations of chronic HF are at high risk for adverse events. Even with appropriate ED management, many require admission for further evaluation and treatment. This score helps identify both:

      • Patients at low risk for adverse events and thus potentially safe for discharge with close follow-up.
      • Patients who are at higher risk and require admission and close monitoring.
    • More widely validated than the Emergency Heart Failure Mortality Risk Grade (EHMRG), but with stricter inclusion/exclusion criteria (see When to Use).
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    Creator Insights
    Dr. Ian Stiell

    About the Creator

    Ian Stiell, MD, MSc, FRCPC, is Professor and Chair, Department of Emergency Medicine, University of Ottawa; Distinguished Professor and University Health Research Chair, University of Ottawa; Senior Scientist, Ottawa Hospital Research Institute; and Emergency Physician, The Ottawa Hospital. He is internationally recognized for his research in emergency medicine with a focus on the development of clinical decision rules and the conduct of clinical trials involving acutely ill and injured patients treated by prehospital services and in emergency departments. He is best known for the development of the Ottawa Ankle Rule, the Canadian C-Spine Rule, and Canadian CT Head Rule and as the Principal Investigator for the landmark OPALS Studies for prehospital care. Dr. Stiell is the Principal Investigator for 1 of 3 Canadian sites in the Resuscitation Outcomes Consortium (ROC) which is funded by CIHR, NIH, HSFC, AHA, and National Defence Canada. Dr. Stiell is a Member of the Institute of Medicine of the U.S. National Academies of Science.

    To read more about Dr. Stiell's work, visit his website.

    To view Dr. Ian Stiell's publications, visit PubMed

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