Estimating prognosis: prognostic scores

Abstract

Prognostic estimation is a complex albeit important process for heart failure patients and their physicians assisting informed decisions. Prognostic scores that incorporate demographic, clinical, physiological, and laboratory characteristics have been developed to enable accurate risk estimation in everyday clinical practice. The usefulness of a prognostic score depends, on one hand, upon its satisfactory performance in discriminating patients prone to manifest an adverse outcome and, on the other hand, on reliably estimating rates of the outcome of interest. These properties should be reproducible in independent cohorts from the population from which a score was derived. Contemporary scores provide an estimate of the long-term prognosis in chronic heart failure and of the short-term and post-discharge prognoses in acute heart failure. While scores predicting mortality have shown modest to good discriminative capacity, estimation of hospitalization risk has proven more difficult, with discrimination of relevant scores being less than modest. Refinement of contemporary scores or development of new ones with the incorporation of novel markers reflecting our increasing understanding of heart failure pathophysiology and progression (such as natriuretic peptides and other biomarkers) may improve predictive ability especially for heart failure hospitalizations. Availability of easily accessible online calculators facilitates the use of prognostic scores in everyday clinical practice.