Brophy et al developed models for predicting survival at 12 and 36 months for a patient with heart failure. This can help identify a patient who may benefit from more aggressive or a novel therapy. The authors are from McGill University, VA Medical Center at Perry Point, and McMaster University.
Parameters:
(1) left ventricular ejection fraction in percent (limits are from 3 to 45%)
(2) NYHA class
(3) cardiothoracic ratio in percent
(4) clinical signs and symptoms (peripheral edema, rales, elevated jugular venous pressure, dyspnea at rest or on exertion, S gallop, limited activity, pulmonary congestion on X-ray)
(5) serum creatinine in mg/dL over range of 0.3 to 3.0 mg/dL
(6) body mass index (BMI) in kg per square meter
(7) systolic blood pressure in mm Hg
(8) etiology of the heart failure
(9) nitrate therapy
(10) age in years
points for the ejection fraction =
= 0.2927 * (45 - (percent LVEF)) / 10
points for serum creatinine =
= 0.548 * (serum creatinine)
|
Parameter |
Finding |
Points |
|
NYHA class |
I |
0 |
|
|
II |
0.2546 |
|
|
III or IV |
0.5093 |
|
cardiothoracic ratio in percent |
<= 50% |
0 |
|
|
> 50% |
0.2927 |
|
number of clinical signs |
0 or 1 |
0 |
|
|
2 or 3 |
0.131 |
|
|
4 or 5 |
0.262 |
|
|
6 or 7 |
0.393 |
|
BMI |
<= 23.6 |
0 |
|
|
23.7 to 26.4 |
0.086 |
|
|
26.5 to 29.7 |
0.172 |
|
|
>= 29.8 |
0.258 |
|
systolic blood pressure |
<= 110 mm Hg |
0 |
|
|
111 to 121 mm Hg |
0.104 |
|
|
122 to 139 mm Hg |
0.208 |
|
|
>= 140 mm Hg |
0.312 |
|
etiology |
diabetic ischemic |
0.3577 |
|
|
other |
0 |
|
nitrate therapy |
no |
0 |
|
|
yes |
0.1656 |
|
age in years |
< 50 years |
0 |
|
|
50 to 59 |
0.1823 |
|
|
60 to 69 |
0.3646 |
|
|
>= 70 |
0.5469 |
where:
• The points in the table are based on the natural logarithm of the hazard ratio (from Table 2) times the reference group from Table 1.
patient sum =
= (points for ejection fraction) + (points for serum creatinine) + SUM(points for points in table)+
Y =
= EXP((patient sum) - 3.10
percent survival at 36 months =
= (0.701 ^ Y)
where:
• 3.10 is the mean value.
• 0.701 is the overall average 36 month survival.
Specialty: Cardiology
ICD-10: ,
