Exam

CHF Decision Rule for Predicting Mortality

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CHF Decision Rule for Predicting Mortality, Congestive Heart Failure Exacerbation Decision Rule

  • Scoring
  • Risk of mortality (for 1 month and 1 year)
  1. Age (in years)
    1. ADD one point for each year of age
  2. Systolic Blood Pressure for 1 month (and 1 year) risk
    1. SUBTRACT 30 points (20 for 1 year risk) SBP <90 mmHg
    2. SUBTRACT 35 points (25 for 1 year risk) SBP 90-99
    3. SUBTRACT 40 points (30 for 1 year risk) SBP 100-119
    4. SUBTRACT 45 points (35 for 1 year risk) SBP 120-139
    5. SUBTRACT 50 points (40 for 1 year risk) SBP 140-159
    6. SUBTRACT 55 points (45 for 1 year risk) SBP 160-179
    7. SUBTRACT 60 points (50 for 1 year risk) SBP >180 mmHg
  3. Respiratory Rate (in breaths per minute)
    1. ADD number of breaths per minute as points up to 45
  4. Blood Urea Nitrogen (BUN as mg/dl)
    1. ADD level of BUN (mg/dl) as points up to 60
  5. Serum Sodium <136 mEq/dl
    1. ADD 10 points
  6. Hemoglobin <10 g/dl
    1. NOTE: Not used for assessing 1 month risk
    2. ADD 10 points if assessing 1 year risk
  7. Comorbidity (1 year risk points noted if different)
    1. Cancer: ADD 15 points
    2. Cerebrovascular Disease: ADD 10 points
    3. Chronic lung disease: ADD 10 points
    4. Dementia: ADD 20 points (15 for 1 year risk)
    5. Hepatic Cirrhosis: ADD 25 points (35 for 1 year risk)
  • Interpretation
  • Mortality Risk per Point Scores
  1. One Month Risk
    1. Points <69: 0.8% mortality over 1 month
    2. Points 69-82: 3.6% mortality over 1 month
    3. Points 83-96: 6.3% mortality over 1 month
    4. Points 97-113: 12.6% mortality over 1 month
    5. Points 114-195: 30.5% mortality over 1 month
  2. One Year Risk
    1. Points <80: 9.0% mortality over 1 year
    2. Points 80-93: 17.7% mortality over 1 month
    3. Points 94-107: 29.1% mortality over 1 month
    4. Points 108-123: 42.1% mortality over 1 month
    5. Points 124-198: 66.3% mortality over 1 month
  • References
  1. Ebell (2007) Am Fam Physician 75:1231-3 [PubMed]
  2. Lee (2003) JAMA 290:2581-7 [PubMed]