The Veterans Affairs Prognostic Score can be used to estimate cardiovascular mortality in patients undergoing exercise testing. This can help in providing informed consent to patients being considered for cardiac surgery.
Patient population: male patients at VA facilities
Exercise protocol: standard treadmill protocols
Parameters:
(1) history of congestive heart failure (CHF) and/or digoxin use
(2) change in the systolic blood pressure during exercise
(3) ST segment depression during exercise
(4) METs during exercise testing
Parameter
Finding
Points
history of congestive heart failure or digoxin use
yes
1
no
0
systolic blood pressure change during exercise
> 40 mm Hg increase
0
31-40 mm Hg
1
21-30 mm Hg
2
11-20 mm Hg
3
0-10 mm Hg
4
< 0 mm Hg (reduction below standing)
5
where:
• The systolic blood pressure change is the difference between the systolic blood pressure during exercise and the systolic blood pressure taken while standing before beginning exercise.
VA prognostic score =
= (5 * (points for CHF or digoxin)) + (ST depression in mm during exercise) + (points for systolic blood pressure change) - (METs)
Interpretation:
• A score < -2 is associated with an annual mortality rate of < 2%.
