Collins et al reported the STRATIFY tool to identify a patient with acute heart failure in the Emergency Department who is likely to experience at adverse effect in the next month. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in the United States.
Patient selection: acute heart failure in the Emergency Department
Outcome: acute coronary syndrome, coronary revascularization, emergency dialysis, intubation, mechanical cardiac support, cardiopulmonary resuscitation, or death within 30 days
Parameters:
(1) age of the patient, from 10 to 100
(2) body mass index (BMI) in kg per square meter, from 15 to 75
(3) serum BNP, from 0 to 5,500 (units not given; presumably pg/mL)
(4) serum BUN in mg/dL
(5) dialysis
(6) diastolic blood pressure in mm Hg, from 20 to 180
(7) serum sodium in mmol/L, from 100 to 150
(8) supplemental oxygen
(9) outpatient ACEI (ACE inhibitor)
(10) QRS duration in ms
(11) respiratory rate in breaths per minute, from 10 to 45
(12) oxygen saturation in percent, from 45 to 100%
(13) serum troponin I, from 0 to 2.6 (units not given; presumed ng/mL)
points for age =
= (0.614 * (age)) - 6.144
points for BMI =
= 56.25 - (0.75 * (BMI))
points for BNP =
= 0.01 * (BNP)
points for diastolic blood pressure =
= 57.6 - (0.32 * (DBP))
points for respiratory rate =
= (2 * (respiratory rate)) - 20.06
points for oxygen saturation =
= 138.18 - (1.38 * (oxygen saturation))
points for serum sodium =
= 273 - (1.82 * (sodium))
|
Serum BUN
|
Points
|
|
< 40
|
(-0.0014 * ((BUN)^2)) + (1.91 * (BUN)) - 0.354
|
|
>= 40
|
(0.52 * (BUN)) + 31.97
|
|
Serum Troponin
|
Points
|
|
0 to 0.2
|
1.65 - (8.25 * (troponin))
|
|
0.2 to 0.4
|
(70 * (troponin)) - 14
|
|
0.4 to 0.6
|
(25 * (troponin)) + 4
|
|
0.6 to 2.6
|
(14.85 * (troponin))+10.09
|
|
Parameter
|
Finding
|
Points
|
|
dialysis
|
no
|
0
|
|
|
yes
|
39.6
|
|
supplemental oxygen
|
no
|
0
|
|
|
yes
|
16.9
|
|
outpatient ACEI therapy
|
no
|
13.6
|
|
|
yes
|
0
|
|
QRS duration
|
<= 120 ms
|
0
|
|
|
> 120 ms
|
15.7
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 688.9
value of X =
= (0.016 * (score)) - 5.69
rate of 30-day adverse event =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve is 0.68.
