Hospital discharge after acute heart failure (AHF) hospitalization is one of the most vulnerable periods for patients. Studies consistently show that the first 90 days after discharge carry a high risk of rehospitalization and mortality.

Clinicians often have to make difficult decisions at discharge:

• Is this patient stable enough to go home?
• Do they need closer follow-up?
• Should we reassess congestion before discharge?

A recent study by Espersen et al. (2024) proposed a simple way to help answer these questions using only four clinical variables measured before discharge.

To make this easier to use at the bedside, I built a simple calculator based on this model.

The Acute Heart Failure Predischarge Risk Calculator

The calculator estimates risk of 90-day heart failure hospitalization or all-cause mortality based on four factors measured before discharge.

Variables Used in the Score

The score assigns one point for each criterion met.

Variable	Threshold
NT-proBNP	≥ 2000 pg/mL
Systolic Blood Pressure	< 120 mmHg
Left Atrial Volume Index (LAVI)	≥ 60 mL/m²
Lung Ultrasound B-Lines	≥ 9

Total possible score: 0-4

Interpreting the Score

Score	Risk Category
0-1	Lower risk
2	Intermediate risk
3-4	Higher risk

Higher scores indicate a greater likelihood of heart failure readmission or death within 90 days after discharge.

This tool is not meant to replace clinical judgment but to support risk stratification during discharge planning.

Why These Variables Matter

NT-proBNP

NT-proBNP reflects cardiac wall stress and congestion. Persistently elevated levels before discharge may indicate incomplete decongestion and ongoing cardiac strain.

Systolic Blood Pressure

Lower systolic blood pressure may indicate reduced cardiovascular reserve and has been associated with worse outcomes in heart failure populations.

Left Atrial Volume Index (LAVI)

LAVI reflects chronic elevation of left atrial pressures and serves as a marker of long-standing diastolic dysfunction.

Lung Ultrasound B-Lines

B-lines detected on lung ultrasound represent pulmonary congestion. Persistent B-lines before discharge suggest residual fluid overload.

Suggested Clinical Use

Patients identified as higher risk before discharge may benefit from:

• Early cardiology follow-up
• Reassessment of congestion
• Optimization of guideline-directed medical therapy
• Consideration of heart failure clinic referral

Lower-risk patients may be appropriate for standard outpatient follow-up and routine monitoring.

Demo of the calculator

Try the AHF Predischarge Risk Calculator

Why I Built This Calculator?

Many existing medical calculators focus on diagnosis or long-term prognosis, but relatively few tools assist with discharge planning in acute heart failure.

The model proposed by Espersen and colleagues is particularly useful because it:

• Uses only four readily available clinical variables
• Can be assessed immediately before discharge
• Identifies patients at higher short-term risk

By converting the model into a simple calculator, the goal is to make the research easier to apply in everyday clinical practice.

Try the AHF Predischarge Risk Calculator

Study Reference

Espersen C, et al. Predictors of heart failure readmission and all-cause mortality in patients with acute heart failure.

International Journal of Cardiology. 2024. DOI: 10.1016/j.ijcard.2024.132036

Clinical Disclaimer

This calculator is intended for educational and clinical support purposes only. It should not replace clinical judgment, guideline-directed care, or individualized patient assessment.