Acute decompensated heart failure (ADHF) remains the most common indication for hospitalization in the U. S., accounting for nearly 1 million admissions annually (1). A small minority of patients (approximately 10%) present with a systolic blood pressure below 120 mm Hg on admission (2). These individuals often have evidence of end-organ dysfunction, particularly prerenal azotemia, and generally have progressive heart failure refractory to outpatient therapy. In-hospital mortality averages 7%, whereas 90-day readmission rates approximate 30%. Data from the Acute Decompensated Heart Failure National Registry (ADHERE), identified elevated blood urea nitrogen (>= 43 mg/dl) as the best single predictor of in-hospital mortality, followed by low systolic blood pressure (< 115 mm Hg) and elevated serum creatinine (>= 2.5 mg/dl) (3). Further, the combination of elevated B-type natriuretic peptide and troponin-I can identify patients with a 12-fold increased risk of death during hospitalization (2). Thus, standard measures readily available at the time of hospital admission or shortly thereafter (e. g., vital signs, laboratory values) can provide an important method for assessing in-hospital mortality risk and for basing decisions on the use of hemodynamic monitoring and intravenous vasoactive therapy.
