A calculation on your doctor's PDA can now estimate your chances of dying within six months of hospital discharge after a first heart attack. The new tool considers nine risk factors, including age, resting heart rate and history of congestive heart failure. The higher the total -- a score can range from 70 (zero risk) to 210 (50 percent risk) -- the greater the risk of death, and the greater the need for aggressive treatment.
Saving GRACE The tool was developed using data collected from 94 hospitals in 14 countries and compiled in the Global Registry of Acute Coronary Events (GRACE). Aventis Pharmaceuticals, maker of the clot prevention drug Lovenox, was a major sponsor of the project. Researchers studied the records of 15,000 heart attack and unstable angina patients to determine which common variables best predicted whether a patient would live or die. Those predictors were then tested against outcomes of 7,638 more patients.
Math with a heart The idea, said Kim Eagle, clinical director of the University of Michigan's Cardiovascular Center and author of a Journal of the American Medical Association study on the model, is to "use mathematical models rather than just horse sense" when treating heart patients. Scoring each risk factor allows a doctor to tailor a treatment plan to a patient's needs -- crucial, Eagle says, because "not all heart attacks are created equal."
Who wants to know? For a patient, knowing one's number can be scary stuff, said Robert DiBianco, chair of medicine at Washington Adventist Hospital. If asked, he'll share the numbers cautiously. "I'm a firm believer that the data we generate is the patient's data, but without [an explanatory] framework there's a lot of room for anxiety." Find the PDA program at www.outcomes-umassmed.org/grace.
-- Matt McMillen