© 2001 European Society of Cardiology
Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two-variable model
Department of Cardiology, University of Heidelberg Bergheimerstr. 58, D-69115 Heidelberg, Germany
* Corresponding author. Tel.: +49-6221-568-611; fax: +49-6221-565-515. E-mail address: christian_zugck{at}med.uni-heidelberg.de (C. Zugck)
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Abstract |
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Aims: The performance of a US-American scoring system (Heart Failure Survival Score, HFSS) was prospectively evaluated in a sample of ambulatory patients with congestive heart failure (CHF). Additionally, it was investigated whether the HFSS might be simplified by assessment of the distance ambulated during a 6-min walk test (6'WT) instead of determination of peak oxygen uptake (peak VO2).
Methods and Results: In 208 middle-aged CHF patients (age 54 ± 10 years, 82% male, NYHA class 2.3 ± 0.7; follow-up 28 ± 14 months) the seven variables of the HFSS: CHF aetiology; heart rate; mean arterial pressure; serum sodium concentration; intraventricular conduction time; left ventricular ejection fraction (LVEF); and peak VO2, were determined. Additionally, a 6'WT was performed. The HFSS allowed discrimination between patients at low, medium and high risk, with mortality rates of 16, 39 and 50%, respectively. However, the prognostic power of the HFSS was not superior to a two-variable model consisting only of LVEF and peak VO2. The areas under the receiver operating curves (AUC) for prediction of 1-year survival were even higher for the two-variable model (0.84 vs. 0.74, P < 0.05). Replacing peak VO2 with 6'WT resulted in a similar AUC (0.83).
Conclusion: The HFSS continued to predict survival when applied to this patient sample. However, the HFSS was inferior to a two-variable model containing only LVEF and either peak VO2 or 6'WT. As the 6'WT requires no sophisticated equipment, a simplified two-variable model containing only LVEF and 6'WT may be more widely applicable, and is therefore recommended.
Key Words: Heart failure • Peak Vo2 • Prognostic model • 6-Min walk test
Received December 15, 2000; Revised February 28, 2001; Accepted May 9, 2001
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