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

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1310-1316
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number12
StatePublished - Dec 1 2014
Externally publishedYes


  • Heart failure
  • Mortality
  • Non-cardiac surgery
  • Risk factors
  • Risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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