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% |
Purpose: To estimate the risk for developing heart failure in a middle age to older adult based on data from the Framingham Study.
Specialty: Cardiology
Objective: risk factors, prevention
ICD-10: I50,
