Patient selection: ambulatory patient with heart failure
Parameters:
(1) prior atherosclerotic vascular event (AVE): myocardial infarction, stroke, lower limb ischemia
(2) left atrial size indexed for BSA in mm per square meter
(3) left ventricular ejection fraction (LVEF) in percent
(4) atrial fibrillation
(5) non-sustained ventricular tachycardia (NSVT) and frequent ventricular premature beats
(6) eGFR in mL per min per 1.73 sq m
(7) serum sodium in mmol/L
(8) serum NT-proBNP in ng/L
(9) serum troponin (positive or negative)
|
Parameter
|
Finding
|
Points for Total Mortality
|
Points for Cardiac Mortality
|
|
prior AVE
|
no
|
0
|
0
|
|
|
yes
|
3
|
3
|
|
left atrial size
|
<= 26
|
0
|
0
|
|
|
> 26
|
8
|
9
|
|
LVEF
|
> 35%
|
0
|
0
|
|
|
<= 35%
|
5
|
5
|
|
atrial fibrillation
|
no
|
0
|
0
|
|
|
yes
|
3
|
0
|
|
NSVT
|
no
|
0
|
0
|
|
|
yes
|
3
|
4
|
|
eGFR
|
>= 60
|
0
|
0
|
|
|
< 60
|
4
|
4
|
|
serum sodium
|
> 138 mmol/L
|
0
|
0
|
|
|
<= 138 mmol/L
|
3
|
3
|
|
NT-proBNP
|
<= 1,000 ng/L
|
0
|
0
|
|
|
> 1,000 ng/L
|
7
|
7
|
|
troponin
|
negative
|
0
|
0
|
|
|
positive
|
4
|
5
|
score for total mortality =
= SUM(points for all of the parameters)
score for cardiac mortality =
= SUM(points for all of the parameters)
Interpretation:
• minimum score for both: 0
• maximum score for both: 40
• For both a score > 20 is associated with high risk.
• The total mortality was 53-55% in the high-risk group and 15% in the low-risk group.
• The cardiac mortality was 45-47% in the high-risk group and 11% in the low-risk group.
Performance:
• The area under the ROC curve is 0.76 for total mortality and 0.78 for cardiac mortality.
