Dixon et al interviewed patients with heart disease and were able to identify high risk patients based on a limited number of clinical measures. This can help identify patients who may benefit from more aggressive intervention. The authors are from three epidemiologic centers in Australia.
Method:
(1) Patients were entered into study if they came to an emergency department with a cardiac diagnosis (angina, myocardial infarction, congestive heart failure). This was termed the "index event".
(2) A followup interview was conducted approximately 4 months (3 to 5 months) after the index event.
Parameters:
(1) age
(2) ever diagnosed as having congestive heart failure (CHF)
(3) another cardiovascular event occurred between index event and followup interview
(4) quality of life, using the MacNew Heart Disease Quality of Life (QoL) instrument
(5) combined factor (presence of both low global QoL and heart failure ever)
|
Parameter
|
Finding
|
Points
|
|
age
|
< 65
|
0
|
|
|
65 - 85
|
9
|
|
ever diagnosed with CHF
|
no
|
0
|
|
|
yes
|
1
|
|
another cardiovascular event in period between index event and interview
|
no
|
0
|
|
|
yes
|
16
|
|
global quality of life (QOL)
|
high
|
0
|
|
|
intermediate
|
0
|
|
|
low
|
1
|
|
combined factor (both low QoL and history of CHF ever)
|
no
|
0
|
|
|
yes
|
15
|
risk index =
= SUM(points for all 5 parameters)
Interpretation:
• minimum index: 0
• maximum index: 42
• The higher the index, the greater the risk.
|
Risk Index
|
Risk
|
Percent Adverse Events
|
|
0
|
low
|
4%
|
|
1 to 10
|
moderate
|
about 12%
|
|
16 or 17
|
high
|
about 30%
|
|
>= 25
|
very high
|
about 50%
|
Figure 1, page 957.
where:
• The use of the combined factor offsets the low values when CHF and low QoL are present separately.
Limitations:
• The followup at 3-5 months may limit applicability for some patients.
• Handling of patients > 85 years can either be done by excluding or assuming similar to 65-85.
• I personally would find it more useful if they had classified the patients according to the initial cardiac event (heart failure, angina, myocardial infarction).
