Lee et al developed a model for predicting 30 day and 1 year mortality rates for a patient admitted to the hospital for heart failure. This can help identify patients who may benefit from more aggressive or novel therapies. The authors are from Toronto General Hospital, Mt. Sinai Hospital and the University of Toronto in Toronto, Ontario.
Endpoints: predicted mortality at 30 day and 1 year
Exclusion criteria:
(1) age >= 105 years of age
(2) development of heart failure after admission
(3) patients transferred from another hospital
(4) nonresidents or those with an invalid health card number
Parameters:
(1) age
(2) respiratory rate in breaths per minute
(3) systolic blood pressure in mm Hg
(4) serum urea nitrogen in mg/dL
(5) serum sodium in mEq/L
(6) cerebrovascular disease
(7) dementia
(8) chronic obstructive pulmonary disease (COPD)
(9) hepatic cirrhosis
(10) cancer
(11) hemoglobin in g/dL
Shared Scoring
|
Parameter |
Finding |
30 Day or 1 Year |
|
age in years |
|
(age in years) |
|
urea nitrogen in mg/dL |
|
MIN(60, level) |
|
serum sodium |
>= 136 mEq/L |
0 |
|
|
< 136 mEq/L |
+10 |
|
cerebrovascular disease |
absent |
0 |
|
|
present |
+10 |
|
COPD |
absent |
0 |
|
|
present |
+10 |
|
cancer |
absent |
0 |
|
|
present |
+15 |
|
respiratory rate per minute |
|
MAX(20,MIN(45, |
Separate Scoring
|
Parameter |
Finding |
30 Day |
1 Year |
|
systolic blood pressure |
>= 180 mm Hg |
-60 |
-50 |
|
|
160 - 179 mm Hg |
-55 |
-45 |
|
|
140 - 159 mm Hg |
-50 |
-40 |
|
|
120 - 139 mm Hg |
-45 |
-35 |
|
|
100 - 119 mm Hg |
-40 |
-30 |
|
|
90 - 99 mm Hg |
-35 |
-25 |
|
|
< 90 mm Hg |
-30 |
-20 |
|
dementia |
absent |
0 |
0 |
|
|
present |
+20 |
+15 |
|
hepatic cirrhosis |
absent |
0 |
0 |
|
|
present |
+25 |
+35 |
|
hemoglobin |
>= 10 g/dL |
0 |
0 |
|
|
< 10 g/dL |
0 |
+10 |
total score for 30 day mortality =
= SUM(points for all parameters)
total score for 1 year mortality =
= SUM(points for all parameters)
Interpretation:
• minimum score for 30 day score: varies with age, probably around 20
• minimum score for 1 year score: varies with age, probably around 40
• maximum for 30 day score: varies with age, probably around 2650
• maximum for 1 year score: varies with age, probably around 290
• The higher the scores the higher the mortality rate.
|
Total Score (30 Day or 1 Year) |
Risk Group |
30 Day Mortality Rate in Percent |
1 Year Mortality Rate in Percent |
|
<= 60 |
very low |
0.4 - 0.6 |
2.7 - 7.8 |
|
61 - 90 |
low |
3.4 - 4.2 |
12.9 - 14.4 |
|
91 - 120 |
intermediate |
12.2 - 13.7 |
30.2 - 32.5 |
|
121 - 150 |
high |
26.0 - 32.7 |
55.5 - 59.3 |
|
> 150 |
very high |
50.0 - 59.0 |
74.7 - 78.8 |
NOTE: At the time of publication an on-line version is available at www.ccort.ca/CHFriskmodel.asp
Performance:
• The area under the ROC curve was 0.80 for 30 day mortality and 0.77 for 1 year mortality.
Purpose: To predict 30 day and 1 year mortality for a patient hospitalized for heart failure using the model of Lee et al.
Specialty: Cardiology
Objective: severity, prognosis, stage
ICD-10: I50,
