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Congestion Score of Lucas et al for Class IV Patients with Heart Failure

Purpose: To evaluate the prognosis for a patient with Class IV heart failure based on findings after management using the congestion score of Lucas et al.

Description

Lucas et al developed a simple score based on signs and symptoms of congestion in heart failure. This can help predict prognosis in patients who present with Class IV heart failure, based on the ability to reverse signs of heart failure by medical management. The authors are from Bringham and Women's Hospital in Boston and UCLA Center for Health Sciences.


Parameters assessed at 1 month after presentation with New York Heart Association Class IV symptoms of heart failure:

(1) orthopnea

(2) jugular venous distention

(3) edema

(4) weight gain

(5) new increase in baseline diuretics

 

Parameter

Finding at 1 Month

Points

orthopnea

absent

0

 

present

1

jugular venous distention

absent

0

 

present

1

edema

absent

0

 

present

1

weight gain

absent

0

 

present

1

new increase in baseline diuretics

absent

0

 

present

1

 

congestion score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 5

• The lower the score, the better the outcome.

• A patient presenting with Class IV symptoms and achieving no signs of congestion after 1 month of management can have a prognosis similar to that of a person with Class III symptoms (Nohria et al).

 

Score

Level of Congestion

Survival at 2 Years

0

none

87%

1 or 2

mild

67%

3, 4 or 5

severe

41%

 


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Specialty

Objective

ICD-10