CHF Prognostication

I favor the model described by Lee et al in the following study:

Predicting Mortality Among Patients Hospitalized for Heart Failure

JAMA.2003;290(19):2581-2587.

ACP Journal Club Commentary.

The actual risk prediction tool uses easily obtained variables (e.g. Age • Respiratory rate • Systolic blood pressure • Blood urea nitrogen • Serum sodium • Comorbid conditions: cerebrovascular disease, dementia, chronic obstructive pulmonary disease, cirrhosis, cancer, anemia) and the 30d. and 1 year risk score can be computed online:

http://www.ccort.ca/Research/CHFRiskModel.aspx

It has also been validated in populations in the US. 

Risk categories (score)	30-day mortality rate		1-year mortality rate
	Derivation	Validation	Derivation	Validation
Very low ( 60)	0.4%	0.6%	7.8%	2.7%
Low (61 to 90)	3.4%	4.2%	12.9%	14.4%
Intermediate (91 to 120)	12.2%	13.7%	32.5%	30.2%
High (121 to 150)	32.7%	26.0%	59.3%	55.5%
Very high (> 150)	59.0%	50.0%	78.8%	74.7%

A more recent article uses the same model to provide a median survival based on the risk scores above:

Life expectancy after an index hospitalization for patients with heart failure: a population-based study.

Am Heart J. 2008 Feb;155(2):324-31. PubMed PMID:18215604.

  

Table II. Mortality and life expectancy for all patients with HF according to the EFFECT HF risk score

	No. of patients	1-y mortality, n (%)	5-y mortality, n (%)	Median survival		Median survival for patients who survived first 3 m after hospitalization
				Months	95% CI	Months	95% CI
All patients with HF	9943	3294 (33.1%)	6833 (68.7%)	29	28-30	41	40-43
Baseline risk⁎
Very low	490	41 (8.4%)	117 (23.9%)	NA	NA	NA	NA
Low	3101	502 (16.2%)	1573 (50.7%)	59	55-62	66	63-71
Intermediate	4225	1450 (34.3%)	3185 (75.4%)	25	24-27	33	32-35
High	1770	1034 (58.4%)	1618 (91.4%)	8	7-9	18	17-20
Very high	357	267 (74.5%)	340 (95.2%)	3	2-4	12	10-15

NA, Not available.

Table IV. Mortality and life expectancy for patients with HF who had LVEF of ≤30% according to the EFFECT HF risk score

	No. of patients, n	1-y mortality, n (%)	5-y mortality, n (%)	Median survival		Median survival for patients who survived first 3 m after hospitalization
				Months	95% CI	Months	95% CI
All patients	1,467	489 (33.3%)	966 (65.8%)	31	27-35	46	42-49
Baseline risk⁎
Very low	131	16 (12.2%)	32 (24.4%)	NA	NA	NA	NA
Low	498	89 (17.9%)	252 (50.6%)	59	51-67	66	60-NA
Intermediate	559	207 (37.0%)	423 (75.7%)	22	19-27	32	28-36
High	225	140 (62.2%)	210 (93.3%)	6	4-9	18	14-21
Very high	54	37 (68.5%)	49 (90.7%)	3	2-8	14	7-24

 

Also useful is the EPERC FAST FACTS on CHF Prognostication and the Readmission Risk Calculator for CHF (also includes MI and Pneumonia).