A risk stratification tool predicted in-hospital mortality in acute decompensated heart failure.

M e t h o d s Design: 2 cohort studies, 1 for derivation and 1 for validation (Acute Decompensated Heart Failure National Registry [ADHERE]). Setting: 263 centers in the United States. Patients: Patients in the ADHERE registry were ≥ 18 years of age and had new-onset ADHF or decompensation of chronic HF with symptoms severe enough to require hospitalization. 33 046 hospitalizations (mean age 73 y, 52% women) from October 2001 to February 2003 formed the derivation cohort, and 32 229 hospitalizations (mean age 73 y, 51% women) from March to July 2003 formed the validation cohort. Description of prediction guide: Classification and regression tree (CART) analysis was used to analyze 39 potential clinical variables of interest in the derivation cohort (demographics [5 variables], primary insurance, HF history [4 variables], medical history [17 variables], laboratory values [9 variables], and initial vital signs [3 variables]). Mortality was calculated for each terminal node in the CART and used to generate a risk stratification model. Patients in the validation cohort were classified into risk groups and compared with those in the derivation cohort. Outcomes: In-hospital mortality.