Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 4, August 2026, pages 321-329

Non-Biomarker Bedside Risk Scores for One-Year Mortality After Acute Heart Failure Hospitalization

↓ Figure 1. Receiver operating characteristic curves for non-biomarker bedside scores and the cross-validated routine-care clinical model. ROC curves are shown for five point scores and the cross-validated routine-care clinical model, including OPTIMIZE-HF–inspired and GWTG-HF–inspired domain scores that were not formal external validations of the original weighted equations. No natriuretic peptide value or AHEAD score was included in the primary analyses. AHEAD: atrial fibrillation, anemia, age, renal dysfunction and diabetes mellitus; AUC: area under the receiver operating characteristic curve; CV: cross-validated; GWTG-HF: Get With The Guidelines-Heart Failure; OPTIMIZE-HF: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure; ROC: receiver operating characteristic.

↓ Figure 2. Likelihood ratios at pragmatic score thresholds. Likelihood ratios were modest across the evaluated non-biomarker point scores, including the inspired domain scores, indicating that these scores should not be used as standalone definitive prognostic instruments. LR: likelihood ratio; GWTG-HF: Get With The Guidelines-Heart Failure; OPTIMIZE-HF: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure.

↓ Figure 3. Grouped calibration of observed 1-year mortality by expanded non-biomarker score group. Observed 1-year all-cause mortality with Wilson 95% confidence intervals is shown across low, intermediate and high categories of the primary expanded non-biomarker 8-item score.

↓ **Table 1.** Baseline Characteristics Overall and by 1-Year Mortality Status
Characteristic	Overall (n = 497)	Survived 1 year (n = 440)	Died within 1 year (n = 57)	P value
Age, years	69.8 ± 15.2	69.3 ± 15.4	74.0 ± 13.5	0.018
Male sex, n (%)	284 (57.1%)	252 (57.3%)	32 (56.1%)	0.984
New York Heart Association class III–IV, n (%)	379 (76.3%)	337 (76.6%)	42 (73.7%)	0.749
Systolic blood pressure, mm Hg	108.9 ± 22.1	109.0 ± 22.2	108.7 ± 21.2	0.941
Heart rate, beats/min	97.3 ± 15.6	97.0 ± 15.5	100.0 ± 16.2	0.197
Hemoglobin, g/L	120.4 ± 23.0	122.0 ± 22.7	107.8 ± 21.5	< 0.001
Creatinine, mg/dL	1.27 (1.09–1.51)	1.26 (1.09–1.51)	1.31 (1.14–1.53)	0.191
Sodium, mmol/L	136.6 ± 4.9	136.7 ± 4.9	136.0 ± 5.0	0.333
Left ventricular ejection fraction, %	33.0 ± 5.9	33.2 ± 5.7	31.3 ± 6.7	0.044
Atrial fibrillation, n (%)	82 (16.5%)	73 (16.6%)	9 (15.8%)	1.000
Diabetes mellitus, n (%)	143 (28.8%)	119 (27.0%)	24 (42.1%)	0.027
Renal disease, n (%)	59 (11.9%)	52 (11.8%)	7 (12.3%)	1.000
Ischemic heart disease, n (%)	260 (52.3%)	233 (53.0%)	27 (47.4%)	0.513

↓ Table 1. Baseline Characteristics Overall and by 1-Year Mortality Status

Characteristic

Overall (n = 497)

Survived 1 year (n = 440)

Died within 1 year (n = 57)

P value

Age, years

69.8 ± 15.2

69.3 ± 15.4

74.0 ± 13.5

0.018

Male sex, n (%)

284 (57.1%)

252 (57.3%)

32 (56.1%)

0.984

New York Heart Association class III–IV, n (%)

379 (76.3%)

337 (76.6%)

42 (73.7%)

0.749

Systolic blood pressure, mm Hg

108.9 ± 22.1

109.0 ± 22.2

108.7 ± 21.2

0.941

Heart rate, beats/min

97.3 ± 15.6

97.0 ± 15.5

100.0 ± 16.2

0.197

Hemoglobin, g/L

120.4 ± 23.0

122.0 ± 22.7

107.8 ± 21.5

< 0.001

Creatinine, mg/dL

1.27 (1.09–1.51)

1.26 (1.09–1.51)

1.31 (1.14–1.53)

0.191

Sodium, mmol/L

136.6 ± 4.9

136.7 ± 4.9

136.0 ± 5.0

0.333

Left ventricular ejection fraction, %

33.0 ± 5.9

33.2 ± 5.7

31.3 ± 6.7

0.044

Atrial fibrillation, n (%)

82 (16.5%)

73 (16.6%)

9 (15.8%)

1.000

Diabetes mellitus, n (%)

143 (28.8%)

119 (27.0%)

24 (42.1%)

0.027

Renal disease, n (%)

59 (11.9%)

52 (11.8%)

7 (12.3%)

1.000

Ischemic heart disease, n (%)

260 (52.3%)

233 (53.0%)

27 (47.4%)

0.513

↓ **Table 2.** A Priori-Defined Non-Biomarker Bedside Score Definitions
Score	Definition	Range
GWTG-HF: Get With The Guidelines-Heart Failure; OPTIMIZE-HF: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure.
Hemodynamic-renal four-item score	1 point each: systolic blood pressure ≤ 100 mm Hg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL.	0–4
OPTIMIZE-HF–inspired domain score	1 point each: age ≥ 75 years; systolic blood pressure ≤ 100 mm Hg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL; left ventricular ejection fraction ≤ 40%. This is an inspired domain-level approximation and not the original OPTIMIZE-HF weighted equation.	0–6
GWTG-HF–inspired domain score	1 point each: age ≥ 75 years; systolic blood pressure ≤ 110 mm Hg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL. Blood urea nitrogen, chronic obstructive pulmonary disease and race were intentionally not approximated; therefore, this is not the original GWTG-HF weighted equation.	0–5
Routine bedside seven-item score	1 point each: age ≥ 75 years; New York Heart Association class III–IV; systolic blood pressure ≤ 100 mmHg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL; left ventricular ejection fraction ≤ 30%.	0–7
Expanded non-biomarker eight-item score (primary score)	Routine bedside seven-item score plus low hemoglobin (hemoglobin < 110 g/L).	0–8
Cross-validated routine-care clinical model	L2-regularized logistic regression using non-biomarker routine-care variables: age, sex, systolic blood pressure, heart rate, New York Heart Association class, hemoglobin, creatinine, sodium, left ventricular ejection fraction, atrial fibrillation, diabetes mellitus, renal disease, and ischemic heart disease. Five-fold stratified cross-validation was used.	Probability

↓ Table 2. A Priori-Defined Non-Biomarker Bedside Score Definitions

Score

Definition

Range

GWTG-HF: Get With The Guidelines-Heart Failure; OPTIMIZE-HF: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure.

Hemodynamic-renal four-item score

1 point each: systolic blood pressure ≤ 100 mm Hg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL.

0–4

OPTIMIZE-HF–inspired domain score

1 point each: age ≥ 75 years; systolic blood pressure ≤ 100 mm Hg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL; left ventricular ejection fraction ≤ 40%. This is an inspired domain-level approximation and not the original OPTIMIZE-HF weighted equation.

0–6

GWTG-HF–inspired domain score

1 point each: age ≥ 75 years; systolic blood pressure ≤ 110 mm Hg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL. Blood urea nitrogen, chronic obstructive pulmonary disease and race were intentionally not approximated; therefore, this is not the original GWTG-HF weighted equation.

0–5

Routine bedside seven-item score

1 point each: age ≥ 75 years; New York Heart Association class III–IV; systolic blood pressure ≤ 100 mmHg; heart rate ≥ 100 beats/min; sodium < 135 mmol/L; creatinine ≥ 1.5 mg/dL; left ventricular ejection fraction ≤ 30%.

0–7

Expanded non-biomarker eight-item score (primary score)

Routine bedside seven-item score plus low hemoglobin (hemoglobin < 110 g/L).

0–8

Cross-validated routine-care clinical model

L2-regularized logistic regression using non-biomarker routine-care variables: age, sex, systolic blood pressure, heart rate, New York Heart Association class, hemoglobin, creatinine, sodium, left ventricular ejection fraction, atrial fibrillation, diabetes mellitus, renal disease, and ischemic heart disease. Five-fold stratified cross-validation was used.

Probability

↓ **Table 3.** Discrimination and Operational Characteristics for 1-Year All-Cause Mortality
Score	AUC (bootstrap 95% CI)	Threshold	Sensitivity	Specificity	LR+	LR-	PPV	NPV
AUC: area under the receiver operating characteristic curve; CI: confidence interval; GWTG-HF: Get With The Guidelines-Heart Failure; OPTIMIZE-HF: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure; LR: likelihood ratio; PPV: positive predictive value; NPV: negative predictive value.
Hemodynamic-renal four-item	0.525 (0.446–0.600)	≥ 2	0.404	0.645	1.14	0.92	0.128	0.893
OPTIMIZE-HF–inspired domain	0.567 (0.492–0.639)	≥ 3	0.667	0.475	1.27	0.70	0.141	0.917
GWTG-HF–inspired domain	0.562 (0.489–0.630)	≥ 3	0.333	0.718	1.18	0.93	0.133	0.893
Routine bedside seven-item	0.563 (0.483–0.634)	≥ 3	0.632	0.480	1.21	0.77	0.136	0.909
Expanded non-biomarker eight-item	0.590 (0.509–0.660)	≥ 4	0.491	0.655	1.42	0.78	0.156	0.909

↓ Table 3. Discrimination and Operational Characteristics for 1-Year All-Cause Mortality

Score

AUC (bootstrap 95% CI)

Threshold

Sensitivity

Specificity

LR+

LR-

PPV

NPV

AUC: area under the receiver operating characteristic curve; CI: confidence interval; GWTG-HF: Get With The Guidelines-Heart Failure; OPTIMIZE-HF: Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure; LR: likelihood ratio; PPV: positive predictive value; NPV: negative predictive value.

Hemodynamic-renal four-item

0.525 (0.446–0.600)

≥ 2

0.404

0.645

1.14

0.92

0.128

0.893

OPTIMIZE-HF–inspired domain

0.567 (0.492–0.639)

≥ 3

0.667

0.475

1.27

0.70

0.141

0.917

GWTG-HF–inspired domain

0.562 (0.489–0.630)

≥ 3

0.333

0.718

1.18

0.93

0.133

0.893

Routine bedside seven-item

0.563 (0.483–0.634)

≥ 3

0.632

0.480

1.21

0.77

0.136

0.909

Expanded non-biomarker eight-item

0.590 (0.509–0.660)

≥ 4

0.491

0.655

1.42

0.78

0.156

0.909

↓ **Table 4.** Observed 1-Year Mortality by Expanded Non-Biomarker Eight-Item Score Group, With Wilson 95% CIs
Primary score group	N	Deaths	Observed 1-year mortality (Wilson 95% CI)
CI: confidence interval.
Low (0–2 points)	196	14	7.1% (4.3–11.6)
Intermediate (3 points)	121	15	12.4% (7.7–19.4)
High (≥ 4 points)	180	28	15.6% (11.0–21.6)

↓ Table 4. Observed 1-Year Mortality by Expanded Non-Biomarker Eight-Item Score Group, With Wilson 95% CIs

Primary score group

Deaths

Observed 1-year mortality (Wilson 95% CI)

CI: confidence interval.

Low (0–2 points)

196

7.1% (4.3–11.6)

Intermediate (3 points)

121

12.4% (7.7–19.4)

High (≥ 4 points)

180

15.6% (11.0–21.6)