Date of Project Completion

Spring 4-13-2021

Document Type

Project Paper

Degree Name

Doctor of Nursing Practice



First Advisor

Carole E. Jenson

Second Advisor

Ann R. Loth





Heart Failure (HF) is a primary diagnosis for hospital admission in adults from the Emergency Department (ED), but not all patients require hospitalization. Emergency Heart Failure Mortality Risk Grade (EHMRG) is designed to estimate mortality in patients with acute HF in ED settings.


To risk-stratify patients with acute HF using EHMRG scores and assess patient safety.


Retrospective cohort analysis of 304 patients with acute HF presenting to an ED at a large tertiary healthcare center. EHMRG scores were calculated per previous thresholds. Mortality and Major Adverse Cardiac Event (MACE) rates were analyzed.


EHMRG risk group respective seven-day mortality rates 0.0% in very low and low-risk groups. Mortality and MACE rates are significantly less in lower-risk groups at 30 days.


ED risk stratification with EHMRG has the potential to revolutionize care for patients with acute HF. Lower-risk patients may be safely discharged or treated in ED observation units (EDOUs).


Acknowledgements: The author would like to thank Dr. Carol Jenson and Dr. Ann Loth as committee co-chairs, and Dr. Kimberly Langer as a WSU faculty committee member. Dr. Bo Madsen and Dr. Stephen Kopecky for support of this project and their clinical expertise in Emergency Medicine and Cardiology; Michele Yeadon APRN, CNP for providing support and clinical expertise as the DNP project site mentor; Angela Fink APRN, CNP and Dr. Casey Clements for offering clinical expertise and insight at the healthcare institution; Aidan Mullan for statistical analysis; Jennifer Condon, Quality Performance Analyst for assistance with clinical data; Alison Schultz, Statistic Program Analyst for developing data queries to obtain data; Diana Albers, Cardiovascular Clinical Research Coordinator for assistance with data entry; and Dr. Michael Osborn for funding support.

Funding: This work was supported by Mayo Clinic (funding from commercial grant awarded to Mayo Clinic).

Related research article was published in Heart & Lung (2023): This DNP research project led to the subsequent article published in Heart & Lung: The Journal of Cardiopulmonary and Acute Care. This journal is "the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders."

Danika M. Nelson, Bo E. Madsen, Stephen L. Kopecky, Carole E. Jenson, Ann R. Loth, Aidan F. Mullan, Casey M. Clements, Grace Lin, Retrospective validation of acute heart failure risk stratification in the emergency department, Heart & Lung, Volume 57, 2023, Pages 31-40, ISSN 0147-9563,

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