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

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Abstract
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 (peakVO2).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 peakVO2, 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 peakVO2. 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 peakVO2with 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 peakVO2or 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.