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

  • Charlotte Andersson
  • Gunnar H. Gislason
  • Mark Hlatky
  • Kathrine Bach Sondergaard
  • Jannik Pallisgaard
  • Gustav Smith
  • Ramachandran S. Vasan
  • Martin G. Larson
  • Per Foge Jensen
  • Lars Kober
  • Christian Torp-Pedersen
Publishing year: 2014
Language: English
Pages: 1310-1316
Publication/Series: European Journal of Heart Failure
Volume: 16
Issue: 12
Document type: Journal article
Publisher: Elsevier

Abstract english

BackgroundHeart 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 resultsAll individuals with heart failure undergoing non-cardiac surgery between October 23 2004 and October 31 2011 were included from Danish administrative registers (n=16827). In total, 1787 (10.6%) died within 30days. 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 56-65years (2), age 66-75years (4), age 76-85years (5), or age >85years (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. ConclusionsFor patients with heart failure, this simple index can accurately identify those at low risk for perioperative mortality.


  • Cardiac and Cardiovascular Systems
  • Heart failure
  • Mortality
  • Non-cardiac surgery
  • Risk factors
  • Risk
  • prediction


  • ISSN: 1879-0844
E-mail: gustav.smith [at]

Associate professor


+46 46 17 26 33



Research project participant

Cardiovascular Epigenetics


Research project participant

Heart Failure and Mechanical Support


Project manager

Molecular Epidemiology and Cardiology

+46 46 17 26 33


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