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

Andersson, Charlotte; Gislason, Gunnar H.; Hlatky, Mark; Sondergaard, Kathrine Bach; Pallisgaard, Jannik; Smith, Gustav LU ; Vasan, Ramachandran S.; Larson, Martin G.; Jensen, Per Foge and Kober, Lars, et al. (2014) In European Journal of Heart Failure 16(12). p.1310-1316
Abstract
BackgroundHeart 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 resultsAll individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n=16827). In total, 1787 (10.6%) died within 30days. 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 56-65years (2), age 66-75years (4), age... (More)
BackgroundHeart 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 resultsAll individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n=16827). In total, 1787 (10.6%) died within 30days. 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 56-65years (2), age 66-75years (4), age 76-85years (5), or age >85years (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. ConclusionsFor patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality. (Less)
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publication status
published
subject
keywords
Heart failure, Mortality, Non-cardiac surgery, Risk factors, Risk, prediction
in
European Journal of Heart Failure
volume
16
issue
12
pages
1310 - 1316
publisher
Elsevier
external identifiers
  • wos:000345755200009
  • scopus:84913603551
ISSN
1879-0844
DOI
10.1002/ejhf.182
language
English
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yes
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6ed442fd-76bb-4213-9e81-39567b70aba1 (old id 4962658)
date added to LUP
2015-02-03 07:04:12
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2017-01-01 03:49:21
@article{6ed442fd-76bb-4213-9e81-39567b70aba1,
  abstract     = {BackgroundHeart 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 resultsAll individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n=16827). In total, 1787 (10.6%) died within 30days. 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 56-65years (2), age 66-75years (4), age 76-85years (5), or age &gt;85years (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 &lt;2% for a score &lt;5 to &gt;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&lt;0.05 performed only slightly better, c-statistic=0.81, but was limited in use by its complexity. ConclusionsFor patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality.},
  author       = {Andersson, Charlotte and Gislason, Gunnar H. and Hlatky, Mark and Sondergaard, Kathrine Bach and Pallisgaard, Jannik and Smith, Gustav and Vasan, Ramachandran S. and Larson, Martin G. and Jensen, Per Foge and Kober, Lars and Torp-Pedersen, Christian},
  issn         = {1879-0844},
  keyword      = {Heart failure,Mortality,Non-cardiac surgery,Risk factors,Risk,prediction},
  language     = {eng},
  number       = {12},
  pages        = {1310--1316},
  publisher    = {Elsevier},
  series       = {European Journal of Heart Failure},
  title        = {A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery},
  url          = {http://dx.doi.org/10.1002/ejhf.182},
  volume       = {16},
  year         = {2014},
}