The Get With The Guidelines–Heart Failure (GWTG‑HF) risk score estimates in-hospital all-cause mortality for adults admitted with acute heart failure, using seven routinely available admission variables: age, systolic blood pressure, heart rate, blood urea nitrogen (BUN), serum sodium, history of chronic obstructive pulmonary disease (COPD), and race (non‑Black vs Black).

Original evidence signal

The score was derived and validated using data from 39 783 patients aged ≥18 years hospitalised with heart failure at 198 US hospitals participating in the American Heart Association GWTG‑HF quality‑improvement program between 2005 and 2007. In-hospital mortality in this cohort was around 3%. Multivariable logistic regression on candidate demographic, medical history and admission laboratory variables identified the seven predictors used in the score. Discrimination for in-hospital mortality was moderate (c‑index about 0.75 in both derivation and validation cohorts) with good calibration across deciles of predicted risk.

GWTG‑HF score	Approx. in-hospital mortality
0–33	<1%
34–50	1–5%
51–57	5–10%
58–61	10–15%
62–65	15–20%
66–70	20–30%
71–74	30–40%
75–78	40–50%
≥79	>50%

These bands come from the original American Heart Association GWTG‑HF risk table and are approximate. Risk increases continuously with higher scores.

External validation and broader use

External evaluations in North American and international cohorts, including UK and Japanese hospital populations, have shown acceptable discrimination for in-hospital mortality, although calibration can vary by setting and may require local recalibration.
The GWTG‑HF score is frequently used as a baseline risk measure in studies of acute heart failure and structural interventions (for example MitraClip and trans-catheter valve procedures), and higher scores are associated with worse short- and longer-term outcomes in these cohorts.

Limitations and cautions

The model predicts in-hospital mortality only. It does not estimate post-discharge outcomes, rehospitalisation or quality of life.
The derivation and validation cohorts were US patients admitted with acute decompensated heart failure at hospitals participating in a quality‑improvement program. Case mix and outcomes may differ in Australian and other health systems.
Race is included as a binary non‑Black vs Black variable and contributes points for non‑Black patients. This reflects associations in the derivation data but should be interpreted cautiously given ongoing concerns about race-based risk adjustment.
The score does not include other potentially important prognostic markers such as natriuretic peptides, detailed renal function beyond BUN, left ventricular ejection fraction, or high-risk comorbidities (e.g. advanced chronic kidney disease, active malignancy). These require separate clinical consideration.

GWTG-Heart Failure Risk Score