MAGGIC heart failure score: how the integer points chart works

The MAGGIC score adds integer points for 13 predictors in a person with heart failure, then reads the 1-year and 3-year death probabilities for that total from the published table. A total of 23 maps to a 1-year probability of 0.134.

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

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Hemodynamics calculators
Pocock SJ et al. · 2013
The MAGGIC formula
Worked examples
Frequently asked questions

What is the MAGGIC score?

MAGGIC stands for the Meta-Analysis Global Group in Chronic Heart Failure. Pocock and colleagues published the score in the European Heart Journal in 2013. Figure 2 of the paper is an integer points chart, and Table 4 maps each total from 0 to 50 to a 1-year and a 3-year probability of death.

Magent's calculator returns the integer score and, for totals up to 50, both probabilities as fractions, such as 0.134. It's a survival estimate and nothing more.

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

The MAGGIC formula

MAGGIC = EF points + age points (by EF column) + SBP points (by EF column)
       + BMI points + creatinine points + NYHA points
       + male 1 + current smoker 1 + diabetes 3 + COPD 2
       + heart failure for more than 18 months 2
       + no beta-blocker prescribed 3 + no ACE inhibitor or ARB prescribed 1

EF columns for the age and SBP points: < 30 · 30 to 39 · ≥ 40
probabilities: Table 4 lookup for totals 0 to 50

Exact expression the calculator uses:

MAGGIC integer score (Pocock 2013 Figure 2): EF <20 7, 20-24 6, 25-29 5, 30-34 3, 35-39 2, >=40 0; age extra by EF (<30 / 30-39 / >=40): <55 0/0/0, 55-59 1/2/3, 60-64 2/4/5, 65-69 4/6/7, 70-74 6/8/9, 75-79 8/10/12, >=80 10/13/15; SBP extra by EF: <110 5/3/2, 110-119 4/2/1, 120-129 3/1/1, 130-139 2/1/0, 140-149 1/0/0, >=150 0/0/0; BMI <15 6, 15-19 5, 20-24 3, 25-29 2, >=30 0; creatinine umol/L <90 0, 90-109 1, 110-129 2, 130-149 3, 150-169 4, 170-209 5, 210-249 6, >=250 8; NYHA I 0, II 2, III 6, IV 8; male 1; current smoker 1; diabetes 3; COPD 2; HF duration >18 months 2; not prescribed beta-blocker 3; not prescribed ACEI/ARB 1; Table 4 1-year and 3-year death probabilities for scores 0-50

Inputs

Input	Meaning	Accepted range
`age`	Age in years	18 to 120
`ef_percent`	Left ventricular ejection fraction, %	1 to 90
`systolic_mm_hg`	Systolic blood pressure, mm Hg	50 to 250
`bmi_kg_m2`	Body mass index, kg/m²	10 to 80
`creatinine_umol_l`	Serum creatinine, µmol/L	9 to 1768
`creatinine_mg_dl`	Or serum creatinine, mg/dL	0.1 to 20
`nyha_class`	NYHA class	1 to 4
`sex`	`female` or `male`
`diabetes`, `copd`, `current_smoker`	Yes or no
`hf_duration_gt_18_months`	Heart failure for more than 18 months	yes or no
`beta_blocker`, `acei_arb`	Prescribed a beta-blocker; prescribed an ACE inhibitor or ARB	yes or no

How the calculation works

Ejection fraction: under 20 scores 7, 20 to 24 scores 6, 25 to 29 scores 5, 30 to 34 scores 3, 35 to 39 scores 2, 40 or more scores 0.
Pick the EF column (under 30, 30 to 39, or 40 or more). Age and systolic pressure points are read from that column, so the same age scores differently at different ejection fractions.
Age: under 55 scores 0 in every column; older age bands add more points, up to 15.
Systolic pressure: lower pressure adds more points; 150 or more scores 0.
BMI, creatinine and NYHA class each add points from their own rows.
Yes/no items: male 1, current smoker 1, diabetes 3, COPD 2, heart failure for more than 18 months 2, no beta-blocker 3, no ACE inhibitor or ARB 1.
Look up the total in Table 4 for the 1-year and 3-year probabilities. Totals above 50 get no probability.

Units

Creatinine bins are in µmol/L. If you have mg/dL, use the mg/dL input; the calculator multiplies by 88.42 first. Give one creatinine input, not both. BMI is entered as a number; the calculator doesn't work it out from height and weight. A missing value or one outside its range is rejected with an error.

Worked examples

These use Magent's own expected values for the calculator. Each shows the 1-year probability.

Example 1: one added factor

Age 50, EF 55, NYHA I, creatinine 80 µmol/L, systolic 150, BMI 30, female, beta-blocker and ACE inhibitor or ARB prescribed, no other factors, plus diabetes.

Every item is in its 0-point row except diabetes → 3.
Score 3; 1-year probability 0.02.

Example 2: a mid-range total

Male, age 70, EF 35, NYHA II, creatinine 120 µmol/L, diabetes, systolic 120, BMI 26, heart failure for more than 18 months, beta-blocker and ACE inhibitor or ARB prescribed.

EF 35 → 2. Age 70 in the 30 to 39 EF column → 8. Systolic 120 in that column → 1.
NYHA II → 2. Creatinine 120 → 2. BMI 26 → 2. Diabetes 3. Duration 2. Male 1.
Score 23; 1-year probability 0.134.

Example 3: same patient, NYHA IV, no beta-blocker, current smoker

NYHA IV scores 8 instead of 2. No beta-blocker adds 3. Current smoker adds 1.
Score 33; 1-year probability 0.316.

Example 4: the last row of Table 4

Male, age 80, EF 15, NYHA IV, creatinine 250 µmol/L, diabetes, systolic 100, BMI 30, COPD, heart failure for more than 18 months, no beta-blocker, no ACE inhibitor or ARB.

EF 15 → 7. Age 80 in the under-30 EF column → 10. Systolic 100 in that column → 5.
NYHA IV 8. Creatinine 250 → 8. BMI 30 → 0. Diabetes 3, COPD 2, duration 2, male 1, no beta-blocker 3, no ACE inhibitor or ARB 1.
Score 50; 1-year probability 0.842.

History of the MAGGIC score

The calculator cites Pocock and colleagues, European Heart Journal, 2013 (volume 34, issue 19, pages 1404–1413). The abstract describes a meta-analysis of individual patient data from cohort studies and clinical trials, covering heart failure with both reduced and preserved ejection fraction. Piecewise Poisson regression with stepwise selection kept 13 predictors, which became the integer chart.

When it's used

The score applies to adults already known to have heart failure, with reduced or preserved ejection fraction.

Where it's used

The score needs an ejection fraction, a blood pressure, BMI, a creatinine result, NYHA class, a few history items and whether two kinds of heart medicine are prescribed.

Who uses it

The person using the calculator enters the 13 items. The calculator adds the points and looks up the probabilities.

Limits of the calculation

The calculator doesn't examine the patient, read an echocardiogram, measure creatinine or work out BMI.
The probabilities are a published table lookup for groups of patients, not a forecast for one person.
Table 4 stops at 50. Above that, the calculator returns the score with no probability.
It isn't NYHA class alone, the ACC/AHA heart failure stages or the Framingham criteria.
This page doesn't say what to do with a score.

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

ACC/AHA heart failure stages assign a stage from A to D and give no probability.
Framingham heart failure criteria count major and minor criteria to decide whether heart failure is present.

Glossary

Ejection fraction (EF): the percentage of blood the left ventricle pumps out with each beat.
NYHA class: New York Heart Association functional class, from I to IV.
Table 4: the paper's lookup of death probabilities by integer score.

Common mistakes

Reading age points from the wrong EF column. Age and systolic points depend on ejection fraction.
Entering creatinine in mg/dL as µmol/L. Use the mg/dL input or convert first.
Scoring a prescribed beta-blocker as 3. The 3 points are for no beta-blocker.
Reading the fraction as a percent. A result of 0.134 is a fraction of 1, not 0.134%.

Source

Pocock SJ, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013;34(19):1404-1413. DOI: 10.1093/eurheartj/ehs337. PMID: 23095984

Frequently asked questions

How is the MAGGIC score calculated?

Add integer points for 13 predictors from the published chart, then look up the total in Table 4.

Why do age and blood pressure points depend on ejection fraction?

The published chart has three EF columns, and age and systolic pressure points differ between them.

What does a MAGGIC score of 23 mean?

Table 4 maps 23 to a 1-year death probability of 0.134.

Is there a probability for scores above 50?

No. Table 4 stops at 50.

Can I enter creatinine in mg/dL?

Yes. The calculator multiplies by 88.42 to get µmol/L.