CHF Decision Rule for Predicting Mortality

I. Scoring: Risk of mortality (for 1 month and 1 year) A. Age (in years) 1. B. ADD one point for each year of age

Systolic Blood Pressure for 1 month (and 1 year) risk 1. 2. 3. 4. 5. 6. 7. SUBTRACT 30 points (20 for 1 year risk) SBP <90 mmHg SUBTRACT 35 points (25 for 1 year risk) SBP 90-99 SUBTRACT 40 points (30 for 1 year risk) SBP 100-119 SUBTRACT 45 points (35 for 1 year risk) SBP 120-139 SUBTRACT 50 points (40 for 1 year risk) SBP 140-159 SUBTRACT 55 points (45 for 1 year risk) SBP 160-179 SUBTRACT 60 points (50 for 1 year risk) SBP >180 mmHg

C.

Respiratory Rate (in breaths per minute) 1. ADD number of breaths per minute as points up to 45

D.

Blood Urea Nitrogen (BUN as mg/dl) 1. ADD level of BUN (mg/dl) as points up to 60

E.

Serum Sodium <136 mEq/dl 1. ADD 10 points

F.

Hemoglobin <10 g/dl 1. 2. NOTE: Not used for assessing 1 month risk ADD 10 points if assessing 1 year risk

G.

Comorbidity (1 year risk points noted if different) 1. 2. 3. Cancer: ADD 15 points Cerebrovascular Disease: ADD 10 points Chronic lung disease: ADD 10 points

4. 5. II.

Dementia: ADD 20 points (15 for 1 year risk) Hepatic Cirrhosis: ADD 25 points (35 for 1 year risk)

Interpretation: Mortality Risk per Point Scores A. One Month Risk 1. 2. 3. 4. 5. B. Points <69: 0.8% mortality over 1 month Points 69-82: 3.6% mortality over 1 month Points 83-96: 6.3% mortality over 1 month Points 97-113: 12.6% mortality over 1 month Points 114-195: 30.5% mortality over 1 month

One Year Risk 1. 2. 3. 4. 5. Points <80: 9.0% mortality over 1 year Points 80-93: 17.7% mortality over 1 month Points 94-107: 29.1% mortality over 1 month Points 108-123: 42.1% mortality over 1 month Points 124-198: 66.3% mortality over 1 month

Definition (CSP) complication of heart diseases; defective cardiac filling and/or impaired contraction and emptying, resulting in the heart's inability to pump a sufficient amount of blood to meet the needs of the body tissues or to be able to do so only with an elevated filling pressure. Definition (NCI) Weakness of the heart muscle that leads to a buildup of fluid in body tissues. Definition (MSH) Heart failure accompanied by EDEMA, such as swelling of the legs and ankles and congestion in the lungs. Definition (NCI) 1. inadequacy of the heart so that as a pump it fails to maintain the circulation of blood, with the result that congestion and edema develop in the tissues; SEE ALSO forward heart failure, backward heart failure, right ventricular failure, left ventricular failure. SYN cardiac failure, cardiac insufficiency, congestive heart failure, myocardial insufficiency. 2. resulting clinical syndromes including

shortness of breath, pitting edema, enlarged tender liver, engorged neck veins, and pulmonary rales in various combinations. Concepts Disease or Syndrome (T047)

ICD9 MSH

428.0, 428.0 D006333

Spanish fallo cardiaco congestivo, insuficiencia cardiaca congestiva Parent Concepts Heart (C0018787), Cardio-vascular Findings: Heart (C0150873), Heart failure (C0018801), Congestive heart failure; nonhypertensive (C0810005), Vascular abnormalities (C0241657), Cardiac Disorders, General, Functional and NEC (C0549515), HEART: MUSCLE/VALVE (C0549605), NonNeoplastic Heart Disorder (C1335015), Heart Diseases (C0018799), Disorder of cardiac ventricle (C1562298)