Prognostic Factors and Risk Scores in Heart Failure

A large number of factors associated with survival in heart failure have been identified. These include demographic factors, patient history, physical examination, routine laboratory tests, biomarkers, ECG and imaging variables as well as functional capacity. Several multivariable risk scores combining these factors have been developed and may help the clinician to gain a more objective measure of prognosis to help guide treatment. These models, however, have only moderate accuracy for predicting mortality and poorer discriminative ability to predict hospitalization. Among the strongest risk markers consistently found are patient symptoms (NYHA class), functional capacity (cardiopulmonary exercise test) and natriuretic peptides. Normal and underweight patients with heart failure have a poorer survival than their overweight and obese counterparts. This has been termed the ‘obesity paradox’ and is discussed.