### Description

Adults with hypertension, coronary artery disease and/or valvular disease are at increased risk for developing heart failure. Certain clinical features in the Framingham Study were associated with risk of heart failure within the 4 years after examination. Since heart failure is associated with increased morbidity and mortality, this can help identify those patients who might benefit from more aggressive therapy.

Populations:

(1) males or females

(2) ages from 45 to 94

(3) patients should have coronary heart disease, hypertension and/or valvular disease.

The data from the Framingham Study was analyzed using a pooled logistic regression model, which is discussed in the next section. To make calculations easier in clinical settings, a point scoring system was developed and is described here.

Males 45 - 94 Years, Table 1

Parameter

Finding

Points

age in years

45 - 49

0

50 - 54

+1

55 - 59

+2

60 - 64

+3

65 - 69

+4

70 - 74

+5

75 - 79

+6

80 - 89

+7

90 - 94

+8

forced vital capacity

>= 4.25 L

0

3.75 - 4.24

+1

3.25 - 3.74

+2

2.75 - 3.24

+3

2.00 - 2.74

+4

1.50 - 1.99

+5

<= 1.49

+6

systolic blood pressure

< 120 mm Hg

0

120 - 139

+1

140 - 169

+2

170 - 189

+3

190 - 219

+4

> 219

+5

heart rate

< 55 beats per minute

0

55 - 64

+1

65 - 79

+2

80 - 89

+3

90 - 99

+4

> 99

+5

left ventricular hypertrophy on ECG

no

0

yes

+5

coronary heart disease

no

0

yes

+9

valve disease

no

0

yes

+5

diabetes mellitus

no

0

yes

+1

cardiomegaly

no

0

yes

+5

from Table 6, page 1201

where:

• The forced vital capacity in Table 6 is given in cL, which I take to be centiliters (0.01 liters).

score =

= SUM(points for parameters present)

Score

4 Year Probability of Developing CHF

0

<1%

5

1%

10

1%

12

2%

14

3%

16

4%

18

5%

20

7%

22

10%

24

14%

25

16%

26

18%

27

21%

28

24%

29

27%

30

31%

31

34%

32

38%

33

42%

34

47%

35

51%

Males 45 - 94 Years, Table 2

Parameter

Finding

Points

age in years

45 - 49

0

50 - 54

+1

55 - 59

+2

60 - 64

+3

65 - 69

+4

70 - 74

+5

75 - 79

+6

80 - 84

+7

85 - 89

+8

90 - 94

+9

systolic blood pressure

< 120 mm Hg

0

120 - 139

+1

140 - 169

+2

170 - 189

+3

190 - 219

+4

> 219

+5

heart rate

< 55 beats per minute

0

55 - 64

+1

65 - 79

+2

80 - 89

+3

90 - 104

+4

> 104

+5

left ventricular hypertrophy on ECG

no

0

yes

+4

coronary heart disease

no

0

yes

+8

valve disease

no

0

yes

+5

diabetes mellitus

no

0

yes

+1

from Table 7, page 1202

score =

= SUM(points for parameters present)

Score

4 Year Probability of Developing CHF

0

< 1%

5

1%

10

2%

12

3%

14

5%

16

8%

18

11%

20

16%

22

22%

24

30%

25

34%

26

39%

27

44%

28

49%

29

54%

30

59%

Women Aged 45-95 Years, Table 1

Parameter

Finding

Points

age in years

45 - 49

0

50 - 59

+1

60 - 69

+2

70 - 79

+3

80 - 89

+4

90 - 94

+5

forced vital capacity

>= 2.99 L

0

2.50 - 2.99

+1

2.00 - 2.49

+2

1.50 - 1.99

+3

< 1.50

+4

systolic blood pressure

< 130 mm Hg

0

130 - 189

+1

> 189

+2

heart rate

< 55 beats per minute

0

55 - 79

+1

80 - 99

+2

> 99

+3

left ventricular hypertrophy on ECG

no

0

yes

+5

coronary heart disease

no

0

yes

+8

valve disease

no

0

yes

+6

cardiomegaly

no

0

yes

+2

diabetes mellitus

no

0

yes, without valve disease

+6

yes, with valve disease

+3

from Table 8, page 1202

score =

= SUM(points for parameters present)

Score

4 Year Probability of Developing CHF

0

< 1%

5

<1%

10

1%

12

1%

14

2%

16

3%

18

4%

20

6%

22

9%

24

13%

25

15%

26

18%

27

21%

28

24%

29

28%

30

32%

31

37%

32

42%

33

46%

34

51%

35

56%

Women Aged 45-95 Years, Table 1

Parameter

Finding

Points

age in years

45 - 49

0

50 - 54

+1

55 - 59

+2

60 - 64

+3

65 - 69

+4

70 - 74

+5

75 - 79

+6

80 - 84

+7

85 - 89

+8

90 - 94

+9

body mass index

< 21 kg per m^2

0

21 - 25

+1

26 - 29

+2

> 29

+3

systolic blood pressure

< 140 mm Hg

0

140 - 209

+1

> 209

+2

heart rate

<= 59 beats per minute

0

60 - 79

+1

80 - 104

+2

> 104

+3

left ventricular hypertrophy on ECG

no

0

yes

+5

coronary heart disease

no

0

yes

+6

valve disease

no

0

yes

+6

diabetes mellitus

no

0

yes, without valve disease

+6

yes, with valve disease

+2

from Table 9, page 1203

score =

= SUM(points for parameters present)

Score

4 Year Probability of Developing CHF

0

< 1%

5

< 1%

10

2%

11

2%

12

3%

13

3%

14

4%

15

5%

16

7%

17

9%

18

11%

19

14%

20

17%

21

21%

22

25%

23

30%

24

36%

25

42%

26

48%

27

54%

28

60%