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ESCAPE Discharge Risk Score of O'Connor et al for a Patient Hospitalized for Advanced Heart Failure

Purpose: To evaluate a patient being discharged following a hospitalization for advanced heart failure using the discharge score from the ESCAPE study.

Description

O'Connor et al developed a score for predicting the risk of mortality for a patient being discharged following hospitalization for advanced heart failure. This can help to identify a patient who may benefit from more aggressive management. The authors are participants in the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) from multiple sites in the United States and Canada.


Parameters:

(1) age in years

(2) serum BUN in mg/dL

(3) 6 minute walk distance in feet

(4) serum sodium in mmol/L

(5) CPR and/or mechanical ventilation required during hospitalization

(6) dose of diuretic at discharge

(7) beta-blocker therapy at discharge

(8) discharge serum BNP in "pg/mmol" (measured using the Shionogi assay)

 

Parameter

Finding

Points

age in years

<= 70 years of age

0

 

> 70 years of age

1

serum BUN

<= 40 mg/dL

0

 

41 to 90 mg/dL

1

 

> 90 mg/dL

2

6 minute walk distance

>= 300 feet

0

 

< 300 feet

1

serum sodium in mmol/L

>= 130 mmol/L

0

 

< 130 mmol/L

1

CPR or mechanical ventilation during hospitalization

no

0

 

yes

2

diuretic dose at discharge

equivalent to <= 240 mg furosemide

0

 

equivalent to > 240 mg furosemide

1

beta-blocker therapy at discharge

yes

0

 

no

1

discharge BNP

<= 500 pmol/L

0

 

500 to 1,300 pmol/L

1

 

> 1,300 pmol/L

3

 

where:

• BNP testing was done using either the Shionogi (Osaka, Japan) or Biosite Triage assay. Results from the Shionogi assay were used to model mortality. The paper mentions units of pg/mmol but other sources use pmol/L. The Triage assay for BNP reports results in pg/mL.

 

total score =

= SUM(points for all 8 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 13

• The higher the score the greater the risk of mortality.

 

Total Score (with BNP)

Probability of Mortality

0

3%

1

7%

2

12%

3

22%

4

37%

5

54%

6

71%

7

83%

8 or higher

91%

 

Performance:

• The area under the ROC curve is 0.78.


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Specialty

Objective

ICD-10