Systems and methods for detecting events indicative of worsening using heart sounds are disclosed. A system can include a signal sensor circuit to sense a heart sound (HS) signal. The system can detect at least first and different second HS components using the HS signal and generate respective first and second HS metrics. The system can determine a trend indicator for the first or second HS metric and selectively generate one or more composite HS metrics using the first and second HS metrics according to the trend indicator indicating a growing or decay trend. The system can include a heart failure (HF) event detector to produce a HF status using the composite HS metrics and output an indication of the HF status or deliver therapy according to the HF status.
