Patient getting emergency room treatment for cardiac emergency (Photo: US Navy via Wikimedia Commons)

Patient getting emergency room treatment for cardiac emergency (Photo: US Navy via Wikimedia Commons)

Heart failure is one of the most common causes of hospitalization and is among the most expensive chronic diseases to treat.  When a patient comes in to the emergency room complaining about having difficulty breathing, shortness of breath, fatigue, or chest tightness, the health care professionals must decide then and there if the patient is at a high or low short-term risk of dying within the next seven days.

Admission to the hospital is often required for patients who were determined to have a high or intermediate-risk.  But, for those who were considered to be low-risk patients, the doctors may just send them home after receiving some medical care at the emergency room.

If a bedside clinical assessment of a heart failure patient isn’t clearly apparent, this could lead to an uncertain prognosis which may cause the doctor to either overestimate or underestimate the risk of death.  This results in some very low-risk patients being hospitalized when they could have been sent home or, conversely, with very high-risk patients who were thought to be safe for discharge being sent home where they soon die.

(Photo: KOMU Photos/Eric Staszczak via Flickr/Creative Commons)

(Photo: KOMU Photos/Eric Staszczak via Flickr/Creative Commons)

Determining whether a heart failure patient is high or low risk is often very challenging, even for the best physicians.  But now, a new web based computer algorithm developed in Canada may help doctors make better decisions on whether the patient stays or is sent back home.

“Doctors estimate the risk of heart failure patients in the emergency department based on best clinical judgment which may include different factors depending on their prior experience,” says Dr. Douglas Lee, a cardiologist at Toronto’s Peter Munk Cardiac Centre, scientist at the Institute for Clinical Evaluative Sciences and Associate Professor of Medicine at the University of Toronto.

Dr. Lee led a team of doctors and scientists to develop the “Emergency Heart Failure Mortality Risk Grade” or EHMRG.  It’s a risk model or algorithm that uses 10 simple predictors such as blood pressure, heart rate, and levels of troponin (an enzyme that’s normally only found in the heart) all of which can indicate potential heart trouble.

Dr. Douglas Lee led team to develop "Emergency Heart Failure Mortality Risk Grade" or EHMRG. (Photo: Peter Munk Cardiac Centre)

Dr. Douglas Lee led team to develop 'Emergency Heart Failure Mortality Risk Grade' or EHMRG. (Photo: Peter Munk Cardiac Centre)

After entering all of the required medical information into the program, available on the web, the program performs calculations and produces an individual probability report on whether that patient could die within the week.

Along with the web-based application Dr. Lee and his team is also developing a version of this program for the smartphone.  Dr. Lee’s goal with this system is to collect data from individual physicians and hospitals that would be used to make comparative studies that would improve the quality of care and also help doctors and hospitals become more cost efficient.

Dr. Lee invites any physician who may be reading this to try their new system. It’s available on the web. The address is

On this week’s radio edition of “Science World” Dr. Lee joins us to talk about this new system and the countless number of lives it could save every year.  Check out the right column for scheduled air-times or listen to the interview with Dr. Lee below.

[audio://|titles=One On One – Dr. Douglas Lee – Heart Failure Diagnostic Program]

Other stories we cover on the “Science World” radio program this week include: