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Background   AHEAD  (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes of acute heart failure. However, the prognostic value of the  AHEAD  score in acute heart failure patients with either reduced or preserved left ventricular ejection fraction ( HF r EF  and  HF p EF ) remain to be elucidated.    Methods and Results  The study population consisted of 2143 patients (age 77±12 years, 68% men, 38%  HF r EF ) hospitalized primarily for acute heart failure with a median follow‐up of 23.75 months. The performance of the  AHEAD  score (atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) was evaluated by Cox's regression analysis for predicting cardiovascular and all‐cause mortality. The mean  AHEAD  scores were 2.7±1.2 in the total study population, 2.6±1.3 in the  HF r EF  group, and 2.7±1.1 in the  HF p EF  group. After accounting for sex, sodium, uric acid, and medications, the  AHEAD  score remained significantly associated with all‐cause and cardiovascular mortality (hazard ratio and 95% CI: 1.49, 1.38–1.60 and 1.48, 1.33–1.64), respectively. The associations of  AHEAD  score with mortality remained significant in the subgroups of  HF r EF  (1.63, 1.47–1.82) and  HF p EF  (1.34, 1.22–1.48). Moreover, when we calculated a new  AHEAD ‐U score by considering uric acid (>8.6 mg/dL) in addition to the  AHEAD  score, the net reclassification was improved by 19.7% and 20.1% for predicting all‐cause and cardiovascular mortality, respectively.    Conclusions  The  AHEAD  score was useful in predicting long‐term mortality in the Asian acute heart failure cohort with either  HF r EF  or  HF p EF . The new  AHEAD ‐U score may further improve risk stratification.

Performance of AHEAD Score in an Asian Cohort of Acute Heart Failure With Either Preserved or Reduced Left Ventricular Systolic Function