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European Heart Journal Advance Access originally published online on February 24, 2009
European Heart Journal 2009 30(9):1088-1096; doi:10.1093/eurheartj/ehp032
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

The MUSIC Risk score: a simple method for predicting mortality in ambulatory patients with chronic heart failure

Rafael Vazquez1,*, Antoni Bayes-Genis2, Iwona Cygankiewicz2, Domingo Pascual-Figal3, Lilian Grigorian-Shamagian4, Ricardo Pavon1, Jose R. Gonzalez-Juanatey4, José M. Cubero1, Luis Pastor1, Jordi Ordonez-Llanos5, Juan Cinca2, Antoni Bayes de Luna2 on behalf of the MUSIC Investigators

1 Cardiology Service, Valme University Hospital, Carretera a Cadiz s/n, 41014 Seville, Spain
2 Cardiology Service, University Hospital Sant Pau, Barcelona, Spain
3 Cardiology Service, University Hospital Arrixaca, Murcia, Spain
4 Cardiology Service, University Hospital Santiago de Compostela, Galicia, Spain
5 Biochemistry Service, Hospital Sant Pau, Barcelona, Spain

Received 24 July 2008; revised 5 January 2009; accepted 8 January 2009; online publish-ahead-of-print 24 February 2009.

* Corresponding author. Tel: +34 61 651 7871, Fax: +34 95 626 6028, Email: plan{at}telefonica.net

Aims: The prognosis of chronic heart failure (CHF) is extremely variable, although generally poor. The purpose of this study was to develop prognostic models for CHF patients.

Methods and results: A cohort of 992 consecutive ambulatory CHF patients was prospectively followed for a median of 44 months. Multivariable Cox models were developed to predict all-cause mortality (n = 267), cardiac mortality (primary end-point, n = 213), pump-failure death (n = 123), and sudden death (n = 90). The four final models included several combinations of the same 10 independent predictors: prior atherosclerotic vascular event, left atrial size >26 mm/m2, ejection fraction ≤35%, atrial fibrillation, left bundle-branch block or intraventricular conduction delay, non-sustained ventricular tachycardia and frequent ventricular premature beats, estimated glomerular filtration rate <60 mL/min/1.73 m2, hyponatremia ≤138 mEq/L, NT-proBNP >1.000 ng/L, and troponin-positive. On the basis of Cox models, the MUSIC Risk scores were calculated. A cardiac mortality score >20 points identified a high-risk subgroup with a four-fold cardiac mortality risk.

Conclusion: A simple score with a limited number of non-invasive variables successfully predicted cardiac mortality in a real-life cohort of CHF patients. The use of this model in clinical practice identifies a subgroup of high-risk patients that should be closely managed.

Key Words: Heart failure • Prognosis • Mortality • Natriuretic peptides


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The MUSIC Risk score: the relevance of competing risks analysis
Darryl P. Leong, et al.
European Heart Journal, 3 Nov 2009 [Full text]

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