# EUROMACS right-sided heart failure score

EUROMACS-RHF

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/euromacs_rhf`
HTML: https://magentlab.com/docs/euromacs-rhf
Markdown: https://magentlab.com/docs/euromacs-rhf.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum Soliman 2018 EUROMACS 9.5-point right-sided heart failure points from five caller-assigned flags after continuous-flow LVAD implant and return score and band (low 0-2, intermediate >2 to 4, high >4).

## When to use

When an agent has already assigned RA/PCWP >0.54, hemoglobin ≤10 g/dL, multiple IV inotropes, INTERMACS class 1-3, and severe RV dysfunction and needs the published 0-9.5 total and band, not a device indication, Michigan RV-failure score, or CRITT score.

## When not to use

- Not a medical device. This is published arithmetic, not an LVAD indication, RVAD indication, or implant timing decision.
- magent does not catheterize, echo, measure hemoglobin, or assign INTERMACS class; the caller supplies five flags. INTERMACS 1, 2, or 3 scores 2 (Soliman 2018). INTERMACS 1-2 only is not the primary paper.
- Not the Michigan RV failure score. Not CRITT.
- Bands follow Soliman 2018: low 0-2 inclusive, intermediate >2 to 4 inclusive, high >4. Score 2.0 is low; 2.5 is intermediate; 4.0 is intermediate; 4.5 is high. Half-points are not integer-rounded.

## Formula

```
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)
```

## Citation

[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](https://doi.org/10.1161/CIRCULATIONAHA.117.030543)
Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TMMH, Bogers AJJC, Zijlstra F, Mohacsi P, Caliskan K, EUROMACS Investigators
Circulation. 2018;137(9):891-906
DOI: [10.1161/CIRCULATIONAHA.117.030543](https://doi.org/10.1161/CIRCULATIONAHA.117.030543)

## Worked example

### All five flags false

Given: `hemoglobin_le_10=false, intermacs_1_to_3=false, multiple_iv_inotropes=false, rap_pcwp_gt_054=false, severe_rv_dysfunction=false`

1. RA/PCWP >0.54 false → 0; Hb ≤10 false → 0; multiple IV inotropes false → 0; INTERMACS 1-3 false → 0; severe RV dysfunction false → 0
2. Score = 0 (max 9.5); band low


### Inotropes, severe RV dysfunction, and RA/PCWP >0.54

Given: `hemoglobin_le_10=false, intermacs_1_to_3=false, multiple_iv_inotropes=true, rap_pcwp_gt_054=true, severe_rv_dysfunction=true`

1. RA/PCWP >0.54 → 2; multiple IV inotropes → 2.5; severe RV dysfunction → 2
2. Score = 6.5 (max 9.5); band high


## Also searched as

- EUROMACS RHF
- EUROMACS right-sided heart failure score
- Soliman 2018
- LVAD right heart failure score
- EUROMACS-RHF
- RA/PCWP INTERMACS RHF score
- continuous flow LVAD RHF score
- right ventricular failure after LVAD

## Parameters

- `rap_pcwp_gt_054` (boolean, required): RA/PCWP ratio >0.54 as assigned by the caller (Soliman 2018). true scores 2. magent does not catheterize or compute the ratio.
- `hemoglobin_le_10` (boolean, required): Hemoglobin ≤10 g/dL as assigned by the caller (Soliman 2018). true scores 1. magent does not measure hemoglobin.
- `multiple_iv_inotropes` (boolean, required): Use of multiple intravenous inotropes as assigned by the caller (Soliman 2018). true scores 2.5. magent does not order inotropes.
- `intermacs_1_to_3` (boolean, required): INTERMACS class 1, 2, or 3 as assigned by the caller (Soliman 2018). true scores 2. The primary paper uses classes 1-3, not 1-2 only. magent does not assign INTERMACS class.
- `severe_rv_dysfunction` (boolean, required): Severe RV dysfunction on echocardiography as assigned by the caller (Soliman 2018). true scores 2. magent does not echo.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/euromacs_rhf`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "hemoglobin_le_10": "false",
      "intermacs_1_to_3": "false",
      "multiple_iv_inotropes": "false",
      "rap_pcwp_gt_054": "false",
      "severe_rv_dysfunction": "false"
    },
    {
      "hemoglobin_le_10": "false",
      "intermacs_1_to_3": "false",
      "multiple_iv_inotropes": "false",
      "rap_pcwp_gt_054": "false",
      "severe_rv_dysfunction": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/euromacs-rhf

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/euromacs_rhf",
  "items": [
    {
      "band": "low",
      "components": [
        {
          "factor": "rap_pcwp_gt_054",
          "points": 0,
          "present": false
        },
        {
          "factor": "hemoglobin_le_10",
          "points": 0,
          "present": false
        },
        {
          "factor": "multiple_iv_inotropes",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "intermacs_1_to_3",
          "points": 0,
          "present": false
        },
        {
          "factor": "severe_rv_dysfunction",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TMMH, Bogers AJJC, Zijlstra F, Mohacsi P, Caliskan K, EUROMACS Investigators",
        "doi": "10.1161/CIRCULATIONAHA.117.030543",
        "id": "soliman-2018",
        "pmid": "28972007",
        "source": "Circulation. 2018;137(9):891-906",
        "title": "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"
      },
      "formula": "euromacs_rhf",
      "formula_expression": "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)",
      "max_score": 9.5,
      "score": 0.0,
      "hemoglobin_le_10": false,
      "intermacs_1_to_3": false,
      "multiple_iv_inotropes": false,
      "rap_pcwp_gt_054": false,
      "severe_rv_dysfunction": false
    },
    {
      "band": "low",
      "components": [
        {
          "factor": "rap_pcwp_gt_054",
          "points": 0,
          "present": false
        },
        {
          "factor": "hemoglobin_le_10",
          "points": 0,
          "present": false
        },
        {
          "factor": "multiple_iv_inotropes",
          "points": 0.0,
          "present": false
        },
        {
          "factor": "intermacs_1_to_3",
          "points": 0,
          "present": false
        },
        {
          "factor": "severe_rv_dysfunction",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TMMH, Bogers AJJC, Zijlstra F, Mohacsi P, Caliskan K, EUROMACS Investigators",
        "doi": "10.1161/CIRCULATIONAHA.117.030543",
        "id": "soliman-2018",
        "pmid": "28972007",
        "source": "Circulation. 2018;137(9):891-906",
        "title": "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"
      },
      "formula": "euromacs_rhf",
      "formula_expression": "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)",
      "max_score": 9.5,
      "score": 0.0,
      "hemoglobin_le_10": false,
      "intermacs_1_to_3": false,
      "multiple_iv_inotropes": false,
      "rap_pcwp_gt_054": false,
      "severe_rv_dysfunction": false
    }
  ]
}
```

## Response fields

- `formula` (string): euromacs_rhf
- `formula_expression` (string): Exact expression used
- `score` (number): Soliman 2018 EUROMACS-RHF points 0-9.5 (half-points allowed; not integer-rounded)
- `max_score` (number): Always 9.5
- `band` (string): Soliman 2018 band: low (0-2 inclusive), intermediate (>2 to 4 inclusive), or high (>4). A band, not a device indication.
- `rap_pcwp_gt_054` (boolean): Whether RA/PCWP >0.54 was assigned true
- `hemoglobin_le_10` (boolean): Whether hemoglobin ≤10 g/dL was assigned true
- `multiple_iv_inotropes` (boolean): Whether multiple IV inotropes was assigned true
- `intermacs_1_to_3` (boolean): Whether INTERMACS class 1-3 was assigned true
- `severe_rv_dysfunction` (boolean): Whether severe RV dysfunction was assigned true
- `components` (array): Per-factor Soliman 2018 points
- `citation` (object): Soliman et al. Circulation 2018 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "band": "low",
  "components": [
    {
      "factor": "rap_pcwp_gt_054",
      "points": 0,
      "present": false
    },
    {
      "factor": "hemoglobin_le_10",
      "points": 0,
      "present": false
    },
    {
      "factor": "multiple_iv_inotropes",
      "points": 0.0,
      "present": false
    },
    {
      "factor": "intermacs_1_to_3",
      "points": 0,
      "present": false
    },
    {
      "factor": "severe_rv_dysfunction",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, Gummert JF, de By TMMH, Bogers AJJC, Zijlstra F, Mohacsi P, Caliskan K, EUROMACS Investigators",
    "doi": "10.1161/CIRCULATIONAHA.117.030543",
    "id": "soliman-2018",
    "pmid": "28972007",
    "source": "Circulation. 2018;137(9):891-906",
    "title": "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"
  },
  "formula": "euromacs_rhf",
  "formula_expression": "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)",
  "max_score": 9.5,
  "score": 0.0,
  "hemoglobin_le_10": false,
  "intermacs_1_to_3": false,
  "multiple_iv_inotropes": false,
  "rap_pcwp_gt_054": false,
  "severe_rv_dysfunction": false
}
```

## Errors

- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

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## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.