The Redin SCORE: Useful, but not for All

We read with great interest the article by Alvarez et al. In a recent issue of the journal1 This study provides a new score that predicts hospitalization for worsening of heart failure (HF) in ambulatory patients. Moreover, the authors state that this score should provide the opportunity to identify those patients requiring care management programmes at specific HF clinics. We would like to comment on some aspects of this paper. In developed countries, ∼2% of the adult population suffers from HF.2 Its prevalence increases exponentially with age. Thus, almost 80% of patients with the disease are aged 65 or older.2, 3 The characteristics of the patients in this study [mean age 66.7 years, predominantly male (69%), with ischaemic aetiology of HF and reduced LVEF] are different from those of the HF patients who are followed at primary care hospitals or seen in the emergency department, where those aged ≥65 years, women, and subjects with hypertension and/or with preserved LVEF are more prevalent. These patients have more co-morbidities and a higher mortality and readmission rate.4-6 Several co-morbidities that may have an effect on the prognosis of elderly HF patients were not mentioned in the article, such as depressive and/or cognitive impairment, frailty, and functional status.7 The impact of these co-morbidities on prognosis may be meaningful in the geriatric HF patient.6, 7 This study also has the limitation of being undertaken only in patients attending at HF clinics, with an inevitable selection bias. Patients with HF may follow specific controls at HF clinics or rather be followed by primary care physicians, geriatricians, or specialists in internal medicine.8 We therefore believe that these results are applicable only in those patients followed in HF clinics and cannot be extrapolated to all patients with HF. A collaboration between cardiologists, emergency physicians, and internists, as in the recently published consensus document for the management of HF,9 represents the ideal situation for the development of prognostic models which should include the entire spectrum of patients with HF. Conflict of interest: none declared