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EUROMACS-RHF score: how the right heart failure points add up

The EUROMACS-RHF score adds weighted points for five findings before a continuous-flow left ventricular assist device (LVAD) is implanted, to estimate the risk of right-sided heart failure afterwards. The total runs from 0 to 9.5 and falls in a low, intermediate or high band.

Not a medical device. Not a diagnosis or dosing recommendation.

Use this calculator via API

What is the EUROMACS-RHF score?

The score comes from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). Soliman and colleagues published it in Circulation in 2018. Right-sided heart failure is a known problem after an LVAD takes over the work of the left ventricle, and the score groups patients by how likely it is.

Magent's calculator takes five yes/no items, adds their points and returns the score, the maximum of 9.5 and the band.

This page explains the arithmetic. It doesn't say what a score means for a particular person.

The EUROMACS-RHF formula

Score = 2   if RA/PCWP ratio > 0.54
      + 1   if hemoglobin ≤ 10 g/dL
      + 2.5 if multiple intravenous inotropes
      + 2   if INTERMACS class 1, 2 or 3
      + 2   if severe right ventricular dysfunction on echocardiography

maximum 9.5
low 0 to 2 · intermediate above 2 up to 4 · high above 4

Exact expression the calculator uses:

EUROMACS-RHF = 2*(rap_pcwp_gt_054) + 1*(hemoglobin_le_10) + 2.5*(multiple_iv_inotropes) + 2*(intermacs_1_to_3) + 2*(severe_rv_dysfunction); Soliman 2018; max 9.5; half-points not integer-rounded; bands low 0-2 inclusive, intermediate >2 to 4 inclusive, high >4; INTERMACS 1-3 (not 1-2 only)

Inputs

InputMeaningPoints if yes
rap_pcwp_gt_054Right atrial to pulmonary capillary wedge pressure ratio above 0.542
hemoglobin_le_10Hemoglobin 10 g/dL or lower1
multiple_iv_inotropesMore than one intravenous inotrope in use2.5
intermacs_1_to_3INTERMACS profile 1, 2 or 32
severe_rv_dysfunctionSevere right ventricular dysfunction on echocardiography2

How the calculation works

  1. Add the points for each item answered yes.
  2. Keep the half-point. Inotropes are worth 2.5, so totals such as 3.5 or 6.5 are reported as they are, not rounded to a whole number.
  3. Band the total: 0 to 2 is low, above 2 up to 4 is intermediate, above 4 is high.

A score of 2.0 is low and 2.5 is intermediate. A score of 4.0 is intermediate and 4.5 is high.

Units

Every input is yes or no. The thresholds behind them use a pressure ratio (no units) and hemoglobin in g/dL. A missing item is rejected with an error.

Worked examples

These use Magent's own expected values for the calculator.

Example 1: no items present

  1. Every item no.
  2. Score 0. Band: low.

Example 2: hemoglobin alone

  1. Hemoglobin 10 g/dL or lower: 1.
  2. Score 1. Band: low.

Example 3: inotropes and hemoglobin

  1. Multiple inotropes 2.5 + hemoglobin 1.
  2. Score 3.5. Band: intermediate.

Example 4: pressure ratio and INTERMACS class

  1. RA/PCWP above 0.54: 2 + INTERMACS 1 to 3: 2.
  2. Score 4. Band: intermediate, because high starts above 4.

Example 5: three items

  1. RA/PCWP above 0.54: 2 + multiple inotropes 2.5 + severe RV dysfunction 2.
  2. Score 6.5. Band: high.

History of the EUROMACS-RHF score

The calculator cites Soliman and colleagues, Circulation, 2018 (volume 137, issue 9, pages 891–906). The abstract describes adults in the EUROMACS registry who received continuous-flow LVADs, split at random into a group to build the score and a group to test it. The main outcome was early severe right-sided heart failure after surgery, defined by the need for right-sided circulatory support, prolonged inotropic support or nitric oxide ventilation.

When it's used

The score describes risk before a continuous-flow LVAD is implanted, using findings from the work-up.

Where it's used

The inputs come from right heart catheterization, a blood count, the medicines in use, the INTERMACS profile and an echocardiogram.

Who uses it

The person using the calculator answers the five items. The calculator adds the points and assigns the band.

Limits of the calculation

  • The calculator doesn't catheterize, measure hemoglobin, read an echocardiogram or assign an INTERMACS profile. Every item comes from the person entering it.
  • The INTERMACS item covers profiles 1 to 3, as in the 2018 paper, not 1 to 2.
  • It isn't the Michigan right ventricular failure score or the CRITT score.
  • It isn't a decision about whether or when to implant an LVAD or a right-sided device, and this page doesn't say what to do with a score.

Clinical decisions belong to a qualified clinician who knows the patient.

  • PAPi is a single hemodynamic index of right ventricular function. EUROMACS-RHF combines five items.
  • Shock index divides heart rate by systolic pressure. EUROMACS-RHF isn't a bedside vital-sign ratio.
  • Cardiac power output measures the heart's pumping power. EUROMACS-RHF is a points score.

Glossary

  • LVAD: left ventricular assist device, a pump that supports the left side of the heart.
  • RA/PCWP: right atrial pressure divided by pulmonary capillary wedge pressure.
  • Inotrope: a medicine that strengthens the heart's contraction.
  • INTERMACS profile: a numbered scale of how unwell a patient with advanced heart failure is, with lower numbers more critical.

Common mistakes

  • Rounding 2.5 to a whole number. The half-point stays in the total.
  • Using INTERMACS 1 to 2. The 2018 score counts profiles 1, 2 and 3.
  • Putting a score of 2 in the intermediate band. Low runs from 0 to 2 inclusive.
  • Putting a score of 4 in the high band. High starts above 4.

Source

Soliman OII, et al. Derivation and Validation of a Novel Right-Sided Heart Failure Model After Implantation of Continuous Flow Left Ventricular Assist Devices: The EUROMACS (European Registry for Patients with Mechanical Circulatory Support) Right-Sided Heart Failure Risk Score. Circulation. 2018;137(9):891-906. DOI: 10.1161/CIRCULATIONAHA.117.030543. PMID: 28847897

Frequently asked questions

What does the EUROMACS-RHF score measure?

The risk of right-sided heart failure after a continuous-flow LVAD is implanted.

What is the highest EUROMACS-RHF score?

9.5.

Why does the score use half-points?

Multiple intravenous inotropes are worth 2.5 points, so totals can end in .5.

What are the EUROMACS-RHF bands?

Low 0 to 2, intermediate above 2 up to 4, and high above 4.

Which INTERMACS profiles count?

Profiles 1, 2 and 3.