Siirila-Waris et al identified risk factors associated with increased mortality at 1 year for a patient hospitalized for acute heart failure. These can help identify patients who may benefit from more aggressive management. The authors are from Helsinki University, Kuopio University and the FINN-AKVA Study Group.
Patient selection: elderly adults admitted with acute heart failure
Outcome: survival at 1 year
Parameters:
(1) gender
(2) age
(3) systolic blood pressure on admission
(4) C-reactive protein (CRP)
(5) serum creatinine
|
Parameter
|
Finding
|
Points
|
|
gender
|
female
|
0
|
|
|
male
|
1
|
|
age of the patient
|
"younger"
|
0
|
|
|
"older"
|
1
|
|
systolic blood pressure
|
low or normotensive
|
1
|
|
|
hypertensive
|
0
|
|
serum C-reactive protein (CRP)
|
<= 10 mg/L
|
0
|
|
|
> 10 mg/L
|
1
|
|
serum creatinine
|
<= 120 µmol/L
|
0
|
|
|
> 120 µmol/L
|
1
|
where:
• There is overlap in the age ranges, with the mean age of survivors 74 years and of deceased 78 years. I will use >= 78 to identify the "older" group.
• The odds ratio for systolic blood pressure was 0.9 per 10 mm Hg increase, indicating that the risk dropped as the pressure increased.
• Disease groups included hypertensive, congestive heart failure, cardiogenic shock, pulmonary edema, and right ventricular failure. Mortality was low for patients with hypertensive heart disease (reflected above) while the mortality rate at 1 year for the other groups ranged from 25 to 43%.
total number of risk factors =
= SUM(points for the 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• The higher the number of risk factors the worse the 1 year mortality rate.
• The odds ratios are in the 1.5 to 1.9 range, which means several have to be present to have a significant impact.
