European Journal of Heart Failure (2014) 16, 1310–1316 doi:10.1002/ejhf.182
A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery Charlotte Andersson1*, Gunnar H. Gislason1,2, Mark A. Hlatky3, Kathrine Bach Søndergaard1, Jannik Pallisgaard1, J. Gustav Smith4, Ramachandran S. Vasan5, Martin G. Larson6, Per Føge Jensen7, Lars Køber8, and Christian Torp-Pedersen9 1 Department
of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens vej 65, DK–2900, Hellerup, Denmark; 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; 3 Department of Cardiology, Clinical Sciences, Lund University, and the Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden; 4 Department of Cardiology, Lund University, and the Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden; 5 Section of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA, USA; 6 Department of Mathematics and Statistics, Boston University, Boston, MA, USA; 7 Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 8 The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; and 9 Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark Received 24 May 2014; revised 26 August 2014; accepted 28 August 2014 ; online publish-ahead-of-print 31 October 2014
Background
Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. ..................................................................................................................................................................... Methods All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 and results were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56–65 years (2), age 66–75 years (4), age 76–85 years (5), or age >85 years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from
A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery Charlotte Andersson1*, Gunnar H. Gislason1,2, Mark A. Hlatky3, Kathrine Bach Søndergaard1, Jannik Pallisgaard1, J. Gustav Smith4, Ramachandran S. Vasan5, Martin G. Larson6, Per Føge Jensen7, Lars Køber8, and Christian Torp-Pedersen9 1 Department
of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens vej 65, DK–2900, Hellerup, Denmark; 2 National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; 3 Department of Cardiology, Clinical Sciences, Lund University, and the Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden; 4 Department of Cardiology, Lund University, and the Department of Heart Failure and Valvular Disease, Skåne University Hospital, Lund, Sweden; 5 Section of Preventive Medicine and Cardiology, Boston University School of Medicine, Boston, MA, USA; 6 Department of Mathematics and Statistics, Boston University, Boston, MA, USA; 7 Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 8 The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; and 9 Institute of Health, Science and Technology, Aalborg University, Aalborg, Denmark Received 24 May 2014; revised 26 August 2014; accepted 28 August 2014 ; online publish-ahead-of-print 31 October 2014
Background
Heart failure is an established risk factor for poor outcomes in patients undergoing non-cardiac surgery, yet risk stratification remains a clinical challenge. We developed an index for 30-day mortality risk prediction in this particular group. ..................................................................................................................................................................... Methods All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 and results were included from Danish administrative registers (n = 16 827). In total, 1787 (10.6%) died within 30 days. In a simple risk score based on the variables from the revised cardiac risk index, plus age, gender, acute surgery, and body mass index category the following variables predicted mortality (points): male gender (1), age 56–65 years (2), age 66–75 years (4), age 76–85 years (5), or age >85 years (7), being underweight (4), normal weight (3), or overweight (1), undergoing acute surgery (5), undergoing high-risk procedures (intra-thoracic, intra-abdominal, or suprainguinal aortic) (3), having renal disease (1), cerebrovascular disease (1), and use of insulin (1). The c-statistic was 0.79 and calibration was good. Mortality risk ranged from
