A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

TY - JOUR

T1 - A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery

AU - Andersson, Charlotte

AU - Gislason, Gunnar H

AU - Hlatky, Mark A

AU - Søndergaard, Kathrine Bach

AU - Pallisgaard, Jannik

AU - Smith, J Gustav

AU - Vasan, Ramachandran S

AU - Larson, Martin G

AU - Jensen, Per Føge

AU - Køber, Lars

AU - Torp-Pedersen, Christian

N1 - © 2014 The Authors European Journal of Heart Failure © 2014 European Society of Cardiology.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - 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 AND RESULTS: All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 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 <2% for a score <5 to >50% for a score ≥20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P < 0.05 performed only slightly better, c-statistic = 0.81, but was limited in use by its complexity.CONCLUSIONS: For patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality.

AB - 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 AND RESULTS: All individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 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 <2% for a score <5 to >50% for a score ≥20. Internal validation by bootstrapping (1000 re-samples) provided c-statistic of 0.79. A more complex risk score based on stepwise logistic regression including 24 variables at P < 0.05 performed only slightly better, c-statistic = 0.81, but was limited in use by its complexity.CONCLUSIONS: For patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality.

U2 - 10.1002/ejhf.182

DO - 10.1002/ejhf.182

M3 - Journal article

C2 - 25359203

SN - 1567-4215

VL - 16

SP - 1310

EP - 1316

JO - European Journal of Heart Failure, Supplement

JF - European Journal of Heart Failure, Supplement

IS - 12

ER -