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

Charlotte Andersson, Gunnar H Gislason, Mark A Hlatky, Kathrine Bach Søndergaard, Jannik Pallisgaard, J Gustav Smith, Ramachandran S Vasan, Martin G Larson, Per Føge Jensen, Lars Køber, Christian Torp-Pedersen

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    Resumé

    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.

    OriginalsprogEngelsk
    TidsskriftEuropean Journal of Heart Failure
    Vol/bind16
    Udgave nummer12
    Sider (fra-til)1310-6
    Antal sider7
    ISSN1388-9842
    DOI
    StatusUdgivet - dec. 2014

    Fingeraftryk

    Body Mass Index
    Logistic Models
    Insulin
    Kidney
    Weights and Measures

    Citer dette

    Andersson, C., Gislason, G. H., Hlatky, M. A., Søndergaard, K. B., Pallisgaard, J., Smith, J. G., ... Torp-Pedersen, C. (2014). A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery. European Journal of Heart Failure, 16(12), 1310-6. https://doi.org/10.1002/ejhf.182
    Andersson, Charlotte ; Gislason, Gunnar H ; Hlatky, Mark A ; Søndergaard, Kathrine Bach ; Pallisgaard, Jannik ; Smith, J Gustav ; Vasan, Ramachandran S ; Larson, Martin G ; Jensen, Per Føge ; Køber, Lars ; Torp-Pedersen, Christian. / A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery. I: European Journal of Heart Failure. 2014 ; Bind 16, Nr. 12. s. 1310-6.
    @article{835142746d8046d5b7f5e90a5c33b8ea,
    title = "A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery",
    abstract = "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.",
    author = "Charlotte Andersson and Gislason, {Gunnar H} and Hlatky, {Mark A} and S{\o}ndergaard, {Kathrine Bach} and Jannik Pallisgaard and Smith, {J Gustav} and Vasan, {Ramachandran S} and Larson, {Martin G} and Jensen, {Per F{\o}ge} and Lars K{\o}ber and Christian Torp-Pedersen",
    note = "{\circledC} 2014 The Authors European Journal of Heart Failure {\circledC} 2014 European Society of Cardiology.",
    year = "2014",
    month = "12",
    doi = "10.1002/ejhf.182",
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    Andersson, C, Gislason, GH, Hlatky, MA, Søndergaard, KB, Pallisgaard, J, Smith, JG, Vasan, RS, Larson, MG, Jensen, PF, Køber, L & Torp-Pedersen, C 2014, 'A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery', European Journal of Heart Failure, bind 16, nr. 12, s. 1310-6. https://doi.org/10.1002/ejhf.182

    A risk score for predicting 30-day mortality in heart failure patients undergoing non-cardiac surgery. / Andersson, Charlotte; Gislason, Gunnar H; Hlatky, Mark A; Søndergaard, Kathrine Bach; Pallisgaard, Jannik; Smith, J Gustav; Vasan, Ramachandran S; Larson, Martin G; Jensen, Per Føge; Køber, Lars; Torp-Pedersen, Christian.

    I: European Journal of Heart Failure, Bind 16, Nr. 12, 12.2014, s. 1310-6.

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

    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

    Y1 - 2014/12

    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

    VL - 16

    SP - 1310

    EP - 1316

    JO - European Journal of Heart Failure

    JF - European Journal of Heart Failure

    SN - 1388-9842

    IS - 12

    ER -