THE CARDIO-PAL SCORE - A NOVEL PROGNOSTICATION TOOL FOR 6-MONTH MORTALITY IN HEART FAILURE INPATIENTS
- 1University of Manitoba
Abstract
BackgroundPatients with heart failure (HF) experience high mortality, yet survival estimates remain challenging. Available prognostic tools commonly predict survival beyond 1-year, limiting goals of care discussions and enrollment on palliative care programs. The objective of this project was to develop a novel prognostic score to better predict 6-month mortality.
MethodsPatients with HF admitted to the St. Boniface Hospital (Winnipeg, Canada) between January 1, 2019 and January 1, 2024 were identified. Patient characteristics, imaging parameters, laboratory values, and functional assessments (Palliative Performance Scale; PPSv2) were collected. Patients were randomly divided into development (80%) and validation (20%) cohorts. Penalized LASSO regression was used to select variables most predictive of 6-month mortality in the development cohort. Retained variables were incorporated into a multivariable logistic regression model to derive the CARDIO-PAL score, the performance of which was assessed in the holdout validation cohort.
ResultsCharacteristics were similar between the development (n = 2036) and validation (n = 508) cohorts, with 6-month mortality rates of 29% and 31%, respectively. 8 candidate variables were retained: age (adjusted odds ratio [aOR] 1.01), PPSv2 (aOR 2.08), systolic blood pressure (aOR 1.14), discontinued use of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (aOR 2.58), beta-blocker (aOR 1.59), and mineralocorticoid receptor antagonist (aOR 2.67), right ventricular systolic pressure (aOR 2.06), and urea (aOR 2.13). The CARDIO- PAL score demonstrated good discrimination, with an area under the curve of 0.80 (95% confidence interval 0.75 - 0.84) and good calibration (slope 0.84, intercept -0.04). 6-month mortality across low, intermediate, and high-risk groups was 2%, 15%, and 54%, respectively.
ConclusionThe CARDIO-PAL score is a novel tool to predict 6-month mortality in HF inpatients. A collaborative approach integrating CARDIO-PAL with other prognostic scores and serial clinical assessments has the potential to promote patient-centered care and improve referral to palliative care programs.
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BibTeX
@misc{bews2026cardiopal,
title = {{THE CARDIO-PAL SCORE - A NOVEL PROGNOSTICATION TOOL FOR 6-MONTH MORTALITY IN HEART FAILURE INPATIENTS}},
author = {H. Bews and j. tam and S. Quan and C. Dolovich and K. Whalen and S.-J. Beaudry and S. Butterworth and A. Southam and J. Pilkey},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.28.26364242},
url = {https://www.medrxiv.org/content/10.64898/2026.09.28.26364242v1},
note = {CC BY-ND},
}
RIS
TY - UNPB
TI - THE CARDIO-PAL SCORE - A NOVEL PROGNOSTICATION TOOL FOR 6-MONTH MORTALITY IN HEART FAILURE INPATIENTS
AU - H. Bews
AU - j. tam
AU - S. Quan
AU - C. Dolovich
AU - K. Whalen
AU - S.-J. Beaudry
AU - S. Butterworth
AU - A. Southam
AU - J. Pilkey
PY - 2026
DA - 2026/09/28
PB - medRxiv
DO - 10.64898/2026.09.28.26364242
UR - https://www.medrxiv.org/content/10.64898/2026.09.28.26364242v1
AB - BackgroundPatients with heart failure (HF) experience high mortality, yet survival estimates remain challenging. Available prognostic tools commonly predict survival beyond 1-year, limiting goals of care discussions and enrollment on palliative care programs. The objective of this project was to develop a novel prognostic score to better predict 6-month mortality. MethodsPatients with HF admitted to the St. Boniface Hospital (Winnipeg, Canada) between January 1, 2019 and January 1, 2024 were identified. Patient characteristics, imaging parameters, laboratory values, and functional assessments (Palliative Performance Scale; PPSv2) were collected. Patients were randomly divided into development (80%) and validation (20%) cohorts. Penalized LASSO regression was used to select variables most predictive of 6-month mortality in the development cohort. Retained variables were incorporated into a multivariable logistic regression model to derive the CARDIO-PAL score, the performance of which was assessed in the holdout validation cohort. ResultsCharacteristics were similar between the development (n = 2036) and validation (n = 508) cohorts, with 6-month mortality rates of 29% and 31%, respectively. 8 candidate variables were retained: age (adjusted odds ratio [aOR] 1.01), PPSv2 (aOR 2.08), systolic blood pressure (aOR 1.14), discontinued use of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (aOR 2.58), beta-blocker (aOR 1.59), and mineralocorticoid receptor antagonist (aOR 2.67), right ventricular systolic pressure (aOR 2.06), and urea (aOR 2.13). The CARDIO- PAL score demonstrated good discrimination, with an area under the curve of 0.80 (95% confidence interval 0.75 - 0.84) and good calibration (slope 0.84, intercept -0.04). 6-month mortality across low, intermediate, and high-risk groups was 2%, 15%, and 54%, respectively. ConclusionThe CARDIO-PAL score is a novel tool to predict 6-month mortality in HF inpatients. A collaborative approach integrating CARDIO-PAL with other prognostic scores and serial clinical assessments has the potential to promote patient-centered care and improve referral to palliative care programs.
ER -