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In people with heart failure, 13 factors are linked with risk for death

Pocock S, Ariti C, McMurray JJ, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies.. Eur Heart J. 2013;34:1404-13.

Review question

In people with heart failure, can the risk of death be predicted?


Heart failure is the weakening of the heart muscle. The weakened heart muscle must work harder to keep blood flowing through the body. People with this condition often complain of feeling tired.

Heart failure develops after an injury to the heart, such as a heart attack, long-term high blood pressure, or an abnormality of one of the heart valves. Heart failure is a major cause of death.

Estimating the chances of death in people with heart failure would help to identify those who need more intensive monitoring and treatment.

How the review was done

The researchers identified 30 cohort studies that included 39,372 people with heart failure (average age 67 years, 67% men). They used the data from these people to develop a risk score to predict death.

What the researchers found

The Heart Failure Risk Score includes 13 factors that were linked to a higher risk of death. Starting with the most important, they are:

  • higher age
  • reduced ability of the heart to pump blood (ejection fraction)
  • higher New York Heart Association Scale (NYHA) ranking
  • reduce kidney function (higher creatinine level)
  • diabetes
  • not using medications that slow down the heartbeat (beta-blockers)
  • lower than normal systolic blood pressure
  • lower body mass index or BMI (body fat in relation to height and weight)
  • more than 18 months since first diagnosis
  • being a smoker
  • chronic obstructive pulmonary disease (COPD)
  • being a man
  • not on medications for high blood pressure (angiotensin-receptor blockers) or kidney damage due to diabetes (ACE inhibitors)

The Heart Failure Risk Calculator is available at


In people with heart failure, 13 factors are linked to a higher risk of death.



Angiotensin-receptor blockers
A group of medications that block the chemicals that tighten the muscles around blood vessels. As a result, blood vessels enlarge and blood pressure is reduced.
Medications that slow down the heartbeat, decrease the force of the contractions of the heart muscles, and reduce blood vessel contraction in the heart, brain, as well as the rest of the body.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.

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