CHF Decision Rule for Predicting Mortality

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

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II. 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)

III. 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

IV. References

  1. Ebell (2007) Am Fam Physician 75:1231-3 [PubMed]
  2. Lee (2003) JAMA 290:2581-7 [PubMed]

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Related Studies

Ontology: Congestive heart failure (C0018802)

Definition (NCI) Failure of the heart to pump a sufficient amount of blood to meet the needs of the body tissues, resulting in tissue congestion and edema. Signs and symptoms include shortness of breath, pitting edema, enlarged tender liver, engorged neck veins, and pulmonary rales.
Definition (NCI_NCI-GLOSS) Weakness of the heart muscle that leads to a buildup of fluid in body tissues.
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 (MSH) Heart failure accompanied by EDEMA, such as swelling of the legs and ankles and congestion in the lungs.
Concepts Disease or Syndrome (T047)
MSH D006333
ICD9 428.0
ICD10 I50.0 , I50.9
SnomedCT 195108009, 155375008, 266308000, 42343007
LNC MTHU020787, LA12740-9
Portuguese INSUFICIENCIA CARDIACA CONGESTIVA, Insuficiência cardíaca congestiva
Spanish INSUFICIENCIA CARDIACA CONGESTIVA, Insuficiencia cardiaca, congestiva, ICC, Fallo cardiaco congestivo, fallo cardíaco congestivo, insuficiencia cardíaca congestiva (trastorno), insuficiencia cardíaca congestiva, Insuficiencia cardiaca congestiva
English CCF - Congestive cardiac fail, CHF NOS, Heart Failure, Congestive, Congestive Heart Failure, congestive heart failure, congestive heart failure (diagnosis), CHF (congestive heart failure), Cardiac failure congestive, Cardiac failure, congestive, CCF, Failure heart congestive, Heart failure, congestive, Congestive heart failure NOS, Heart Failure [Disease/Finding], Cardiac Failure, Heart Failure, cardiac congestive failure, congestive disease heart, congestive failure heart, congestive heart failure chf, heart congestive failure, heart failure congestive, congestive failure hearts, Failure;congestive cardiac, congestive heart failure (CHF), congestive failures heart, cardiac failure congestive, ccf, disease congestive heart, congestive diseases heart, congestive heart disease, failure congestive heart, CHF, Congestive cardiac fail, Congetive cardiac failure, FAILURE, CONGESTIVE HEART, CONGESTIVE HEART FAILURE, HEART FAILURE, CONGESTIVE, Congestive heart failure (CHF), Congestive heart disease, CCF - Congestive cardiac failure, CHF - Congestive heart failure, Congestive cardiac failure, Congestive heart failure (disorder), congestive; heart, failure; heart, congestive, heart failure; congestive, heart; congestive, heart; disease, congestive, Cardiac Failure Congestive, Congestive heart failure, unspecified, Congestive heart failure, congestive cardiac failure
Italian Insufficienza cardiaca congestizia, Scompenso cardiaco congestizio
Dutch CHF, congestief hartfalen, hartfalen, congestief, CCF, hartdecompensatie met stuwing (congestie), falen; hart, congestief, hart; aandoening, stuwing, hart; stuwing, hartfalen; congestief, stuwing; hart, Hartdecompensatie met stuwing, hartfalen congestief
French Insuffisance cardiaque, congestive, ICC (Insuffisance cardiaque congestive), ICC, Défaillance cardiaque congestive, Insuffisance cardiaque congestive, DEFAILLANCE CARDIAQUE CONGESTIVE
German Versagen des Herzens, kongestiv, CHF, kongestives Herzversagen, Herzversagen, kongestiv, CCF, Kongestive Herzinsuffizienz, Herzinsuffizienz, kongestive, STAUUNGSINSUFFIZIENZ, Herzinsuffizienz dekompensiert
Japanese うっ血性心不全, ｳｯｹﾂｾｲｼﾝﾌｾﾞﾝ
Czech Městnavé srdeční selhání, Kongestivní srdeční selhání, Srdeční selhání, kongestivní, Selhání srdce s kongescí, Srdeční selhání s kongescí, CHSS, srdeční selhání městnavé, městnavé srdeční selhání, srdce - selhání městnavé, městnavé selhání srdce, kongestivní srdeční selhání
Korean 울혈성 심장기능상실(심부전)
Hungarian CCF, CHF, Congestiv szívelégtelenség, Szívelégtelenség, congestiv, Szívelégtelenség, pangásos, Szívelégtelenség pangásos, Pangásos szívelégtelenség
Norwegian Hjertesvikt, kongestiv, Hjertesykdom med stuvningssvikt, Kongestiv hjertesvikt
Derived from the NIH UMLS (Unified Medical Language System)

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