Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative <scp>NT</scp>‐pro<scp>BNP</scp>

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>We previously developed the Ottawa Heart Failure Risk Scale (<jats:styled-content style="fixed-case">OHFRS</jats:styled-content>) to assist with disposition decisions for acute heart failure patients in the emergency department (<jats:styled-content style="fixed-case">ED</jats:styled-content>). We sought to prospectively evaluate the accuracy, acceptability, and potential impact of <jats:styled-content style="fixed-case">OHFRS</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This prospective observational cohort study was conducted at six tertiary hospital <jats:styled-content style="fixed-case">ED</jats:styled-content>s. Patients with acute heart failure were evaluated by <jats:styled-content style="fixed-case">ED</jats:styled-content> physicians for the 10 <jats:styled-content style="fixed-case">OHFRS</jats:styled-content> criteria and then followed for 30 days. Quantitative <jats:styled-content style="fixed-case">NT</jats:styled-content>‐pro<jats:styled-content style="fixed-case">BNP</jats:styled-content> was measured where feasible. Serious adverse event (<jats:styled-content style="fixed-case">SAE</jats:styled-content>) was defined as death within 30 days, admission to monitored unit, intubation, noninvasive ventilation, myocardial infarction, or relapse resulting in hospital admission within 14 days.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We enrolled 1,100 patients with mean (±<jats:styled-content style="fixed-case">SD</jats:styled-content>) age 77.7 (±10.7) years. <jats:styled-content style="fixed-case">SAE</jats:styled-content>s occurred in 170 (15.5%) cases (19.4% if admitted and 10.2% if discharged). Compared to actual practice, using an admission threshold of <jats:styled-content style="fixed-case">OHFRS</jats:styled-content> score > 1 would have increased sensitivity (71.8% vs. 91.8%) but increased admissions (57.2% vs. 77.6%). For 684 cases with <jats:styled-content style="fixed-case">NT</jats:styled-content>‐pro<jats:styled-content style="fixed-case">BNP</jats:styled-content> values, using a threshold score > 1 would have significantly increased sensitivity (69.8% vs. 95.8%) while increasing admissions (60.8% vs. 88.0%). In only 11.9% of cases did physicians indicate discomfort with use of <jats:styled-content style="fixed-case">OHFRS</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Prospective clinical validation found the <jats:styled-content style="fixed-case">OHFRS</jats:styled-content> tool to be highly sensitive for <jats:styled-content style="fixed-case">SAE</jats:styled-content>s in acute heart failure patients, albeit with an increase in admission rates. When available, <jats:styled-content style="fixed-case">NT</jats:styled-content>‐pro<jats:styled-content style="fixed-case">BNP</jats:styled-content> values further improve sensitivity. With adequate physician training, <jats:styled-content style="fixed-case">OHFRS</jats:styled-content> should help improve and standardize admission practices, diminishing both unnecessary admissions for low‐risk patients and unsafe discharge decisions for high‐risk patients.</jats:p></jats:sec>