# HFA-ICOS myeloma-therapy baseline CV risk HFA-ICOS myeloma-therapy baseline CV risk Status: LIVE Price: $0.005 USDC `GET /api/calc/hfa_icos_myeloma` HTML: https://magentlab.com/docs/hfa-icos-myeloma Markdown: https://magentlab.com/docs/hfa-icos-myeloma.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Lyon 2020 HFA-ICOS multiple-myeloma therapy baseline cardiovascular risk proforma from caller-assigned age, LVEF, and published Very high, High, Medium 2, and Medium 1 factors before proteasome inhibitors and immunomodulatory drugs. Returns risk_level, medium_points, and the paper's expert-opinion cardiotoxicity_guide. ## When to use When an agent already has the published myeloma-therapy-table assignments (age, LVEF, and yes/no factors) and needs the HFA-ICOS class. magent does not examine the patient, read imaging, assay labs, compute BMI, or compute a steroid dose. ## When not to use - Not a medical device and not a diagnosis or treatment order. - magent does not examine the patient or read imaging. Age, LVEF, and yes/no factors are caller-assigned. - Classification follows Lyon 2020: very high if any Very high factor; else high if any High factor or medium_points >=5; else medium if medium_points 2-4; else low (no factors or one Medium 1). - medium_points sums only Medium 1 (1) and Medium 2 (2). High and Very high do not add to medium_points. - Age bands are mutually exclusive (highest matching): >=75 High; 65-74 Medium 1; <65 none. LVEF: <50 High; 50-54 Medium 2; >=55 none. - BNP or NT-proBNP above local ULN is High on this table and does not add a medium point. Troponin above local ULN is Medium 2. - High-dose dexamethasone (>160 mg/month) and obesity (BMI >30) are caller-assigned. magent does not compute a steroid dose or BMI. - cardiotoxicity_guide is the paper's expert-opinion guide (low <2%, medium 2-9%, high 10-19%, very high >=20%), not a validated absolute risk. - Not a chemotherapy, imaging, or cardioprotective-drug order. ## Formula ``` very_high if any Very high factor (heart_failure_or_cardiomyopathy, prior_proteasome_inhibitor_cardiotoxicity, venous_thrombosis, cardiac_amyloidosis, arterial_vascular_disease); else high if any High factor (prior_immunomodulatory_drug_cv_toxicity, lvef_percent<50, elevated_bnp, age_years>=75, prior_anthracycline) OR medium_points>=5; else medium if medium_points in 2..4; else low (no factors or one Medium 1). medium_points sums Medium 1 (=1: left_ventricular_hypertrophy, age_years 65-74, hypertension, diabetes, hyperlipidemia, ckd, family_history_thrombophilia, prior_thoracic_spine_radiotherapy, high_dose_dexamethasone, current_or_significant_smoker, obesity) and Medium 2 (=2: lvef_percent 50-54, arrhythmia, elevated_troponin) only. Age and LVEF use the highest matching printed band. Lyon 2020 HFA-ICOS multiple-myeloma therapy table. cardiotoxicity_guide is that paper's expert-opinion guide: low <2%, medium 2-9%, high 10-19%, very high >=20% ``` ## Citation [Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society](https://doi.org/10.1002/ejhf.1920) Lyon AR, Dent S, Stanway S, et al. Eur J Heart Fail. 2020;22(11):1945-1960 DOI: [10.1002/ejhf.1920](https://doi.org/10.1002/ejhf.1920) ## Worked example ### No factors, age 50, LVEF 60 Given: `age_years=50, arrhythmia=false, arterial_vascular_disease=false, cardiac_amyloidosis=false, ckd=false, current_or_significant_smoker=false, diabetes=false, elevated_bnp=false, elevated_troponin=false, family_history_thrombophilia=false, heart_failure_or_cardiomyopathy=false, high_dose_dexamethasone=false, hyperlipidemia=false, hypertension=false, left_ventricular_hypertrophy=false, lvef_percent=60, obesity=false, prior_anthracycline=false, prior_immunomodulatory_drug_cv_toxicity=false, prior_proteasome_inhibitor_cardiotoxicity=false, prior_thoracic_spine_radiotherapy=false, venous_thrombosis=false` 1. no Very high or High factor 2. medium_points = 0 3. risk_level is low 4. cardiotoxicity_guide is <2% ### Age 70 only Given: `age_years=70, arrhythmia=false, arterial_vascular_disease=false, cardiac_amyloidosis=false, ckd=false, current_or_significant_smoker=false, diabetes=false, elevated_bnp=false, elevated_troponin=false, family_history_thrombophilia=false, heart_failure_or_cardiomyopathy=false, high_dose_dexamethasone=false, hyperlipidemia=false, hypertension=false, left_ventricular_hypertrophy=false, lvef_percent=60, obesity=false, prior_anthracycline=false, prior_immunomodulatory_drug_cv_toxicity=false, prior_proteasome_inhibitor_cardiotoxicity=false, prior_thoracic_spine_radiotherapy=false, venous_thrombosis=false` 1. age 65-74 is Medium 1 2. medium_points = 1 3. risk_level is low (medium needs 2-4) ### Age 75 only Given: `age_years=75, arrhythmia=false, arterial_vascular_disease=false, cardiac_amyloidosis=false, ckd=false, current_or_significant_smoker=false, diabetes=false, elevated_bnp=false, elevated_troponin=false, family_history_thrombophilia=false, heart_failure_or_cardiomyopathy=false, high_dose_dexamethasone=false, hyperlipidemia=false, hypertension=false, left_ventricular_hypertrophy=false, lvef_percent=60, obesity=false, prior_anthracycline=false, prior_immunomodulatory_drug_cv_toxicity=false, prior_proteasome_inhibitor_cardiotoxicity=false, prior_thoracic_spine_radiotherapy=false, venous_thrombosis=false` 1. age >=75 is High 2. medium_points = 0 3. risk_level is high ### Elevated BNP Given: `age_years=50, arrhythmia=false, arterial_vascular_disease=false, cardiac_amyloidosis=false, ckd=false, current_or_significant_smoker=false, diabetes=false, elevated_bnp=true, elevated_troponin=false, family_history_thrombophilia=false, heart_failure_or_cardiomyopathy=false, high_dose_dexamethasone=false, hyperlipidemia=false, hypertension=false, left_ventricular_hypertrophy=false, lvef_percent=60, obesity=false, prior_anthracycline=false, prior_immunomodulatory_drug_cv_toxicity=false, prior_proteasome_inhibitor_cardiotoxicity=false, prior_thoracic_spine_radiotherapy=false, venous_thrombosis=false` 1. elevated_bnp is High on this table 2. does not add a medium point 3. risk_level is high ### Elevated troponin only Given: `age_years=50, arrhythmia=false, arterial_vascular_disease=false, cardiac_amyloidosis=false, ckd=false, current_or_significant_smoker=false, diabetes=false, elevated_bnp=false, elevated_troponin=true, family_history_thrombophilia=false, heart_failure_or_cardiomyopathy=false, high_dose_dexamethasone=false, hyperlipidemia=false, hypertension=false, left_ventricular_hypertrophy=false, lvef_percent=60, obesity=false, prior_anthracycline=false, prior_immunomodulatory_drug_cv_toxicity=false, prior_proteasome_inhibitor_cardiotoxicity=false, prior_thoracic_spine_radiotherapy=false, venous_thrombosis=false` 1. elevated_troponin is Medium 2 2. medium_points = 2 3. risk_level is medium ### Five Medium 1 factors Given: `age_years=50, arrhythmia=false, arterial_vascular_disease=false, cardiac_amyloidosis=false, ckd=true, current_or_significant_smoker=false, diabetes=true, elevated_bnp=false, elevated_troponin=false, family_history_thrombophilia=false, heart_failure_or_cardiomyopathy=false, high_dose_dexamethasone=false, hyperlipidemia=true, hypertension=true, left_ventricular_hypertrophy=false, lvef_percent=60, obesity=true, prior_anthracycline=false, prior_immunomodulatory_drug_cv_toxicity=false, prior_proteasome_inhibitor_cardiotoxicity=false, prior_thoracic_spine_radiotherapy=false, venous_thrombosis=false` 1. five Medium 1 factors 2. medium_points = 5 3. risk_level is high ## Also searched as - HFA-ICOS myeloma - HFA ICOS multiple myeloma CV risk - Lyon 2020 myeloma therapy risk - proteasome inhibitor cardiotoxicity risk - immunomodulatory drug cardiovascular risk - cardio-oncology myeloma baseline - ESC Heart Failure Association ICOS myeloma - HFA-ICOS very high high medium low myeloma ## Parameters - `age_years` (integer, required): Age in years (18-100, integer). Lyon 2020 myeloma-therapy table: >=75 High; 65-74 Medium 1; <65 no age factor. Highest matching band only. - `lvef_percent` (integer, required): LVEF percent (10-80, integer). Lyon 2020: <50 High; 50-54 Medium 2; >=55 no LVEF factor. Highest matching printed band only. magent does not read imaging. - `heart_failure_or_cardiomyopathy` (boolean, required): Heart failure or cardiomyopathy (Lyon 2020 Very high). true or false as assigned by the caller. magent does not examine the patient or read imaging. - `prior_proteasome_inhibitor_cardiotoxicity` (boolean, required): Prior proteasome-inhibitor cardiotoxicity (Lyon 2020 Very high). true or false as assigned by the caller. - `venous_thrombosis` (boolean, required): Venous thrombosis (DVT or PE) (Lyon 2020 Very high). true or false as assigned by the caller. magent does not diagnose thrombosis. - `cardiac_amyloidosis` (boolean, required): Cardiac amyloidosis (Lyon 2020 Very high). true or false as assigned by the caller. magent does not read imaging or biopsy. - `arterial_vascular_disease` (boolean, required): Arterial vascular disease (IHD, PCI, CABG, stable angina, TIA, stroke, or PVD) as one caller bool (Lyon 2020 Very high). true or false. magent does not diagnose vascular disease. - `prior_immunomodulatory_drug_cv_toxicity` (boolean, required): Prior immunomodulatory-drug cardiovascular toxicity (Lyon 2020 High). true or false as assigned by the caller. - `elevated_bnp` (boolean, required): Baseline BNP or NT-proBNP above the local laboratory ULN as assigned by the caller (Lyon 2020 High). true or false. magent does not assay natriuretic peptides. - `prior_anthracycline` (boolean, required): Prior anthracycline exposure (Lyon 2020 High). true or false as assigned by the caller. - `arrhythmia` (boolean, required): Arrhythmia (Lyon 2020 Medium 2). true or false as assigned by the caller. magent does not read a rhythm strip. - `elevated_troponin` (boolean, required): Baseline troponin above the local laboratory ULN as assigned by the caller (Lyon 2020 Medium 2). true or false. magent does not assay troponin. - `left_ventricular_hypertrophy` (boolean, required): Left-ventricular hypertrophy (Lyon 2020 Medium 1). true or false as assigned by the caller. magent does not read imaging. - `hypertension` (boolean, required): Hypertension as assigned by the caller (Lyon 2020 Medium 1). true or false. magent does not measure blood pressure. - `diabetes` (boolean, required): Diabetes mellitus as assigned by the caller (Lyon 2020 Medium 1). true or false. magent does not assay HbA1c. - `hyperlipidemia` (boolean, required): Hyperlipidemia as assigned by the caller (Lyon 2020 Medium 1). true or false. magent does not assay lipids. - `ckd` (boolean, required): Chronic kidney disease as assigned by the caller (Lyon 2020 Medium 1). true or false. magent does not compute eGFR. - `family_history_thrombophilia` (boolean, required): Family history of thrombophilia (Lyon 2020 Medium 1). true or false as assigned by the caller. magent does not take a family history. - `prior_thoracic_spine_radiotherapy` (boolean, required): Prior thoracic-spine radiotherapy (Lyon 2020 Medium 1). true or false as assigned by the caller. - `high_dose_dexamethasone` (boolean, required): High-dose dexamethasone (>160 mg/month) as assigned by the caller (Lyon 2020 Medium 1). true or false. magent does not compute a steroid dose. - `current_or_significant_smoker` (boolean, required): Current smoker or significant smoking history (Lyon 2020 Medium 1). true or false as assigned by the caller. - `obesity` (boolean, required): Obesity (BMI >30 kg/m2) as assigned by the caller (Lyon 2020 Medium 1). true or false. magent does not compute BMI. ## 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/hfa_icos_myeloma` 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": [ { "age_years": "50", "arrhythmia": "false", "arterial_vascular_disease": "false", "cardiac_amyloidosis": "false", "ckd": "false", "current_or_significant_smoker": "false", "diabetes": "false", "elevated_bnp": "false", "elevated_troponin": "false", "family_history_thrombophilia": "false", "heart_failure_or_cardiomyopathy": "false", "high_dose_dexamethasone": "false", "hyperlipidemia": "false", "hypertension": "false", "left_ventricular_hypertrophy": "false", "lvef_percent": "60", "obesity": "false", "prior_anthracycline": "false", "prior_immunomodulatory_drug_cv_toxicity": "false", "prior_proteasome_inhibitor_cardiotoxicity": "false", "prior_thoracic_spine_radiotherapy": "false", "venous_thrombosis": "false" }, { "age_years": "50", "arrhythmia": "false", "arterial_vascular_disease": "false", "cardiac_amyloidosis": "false", "ckd": "false", "current_or_significant_smoker": "false", "diabetes": "false", "elevated_bnp": "false", "elevated_troponin": "false", "family_history_thrombophilia": "false", "heart_failure_or_cardiomyopathy": "false", "high_dose_dexamethasone": "false", "hyperlipidemia": "false", "hypertension": "false", "left_ventricular_hypertrophy": "false", "lvef_percent": "60", "obesity": "false", "prior_anthracycline": "false", "prior_immunomodulatory_drug_cv_toxicity": "false", "prior_proteasome_inhibitor_cardiotoxicity": "false", "prior_thoracic_spine_radiotherapy": "false", "venous_thrombosis": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/hfa-icos-myeloma Example 200: ```json { "count": 2, "path": "/api/calc/hfa_icos_myeloma", "items": [ { "components": [ { "factor": "heart_failure_or_cardiomyopathy", "points": 0, "present": false, "tier": "very_high" }, { "factor": "prior_proteasome_inhibitor_cardiotoxicity", "points": 0, "present": false, "tier": "very_high" }, { "factor": "venous_thrombosis", "points": 0, "present": false, "tier": "very_high" }, { "factor": "cardiac_amyloidosis", "points": 0, "present": false, "tier": "very_high" }, { "factor": "arterial_vascular_disease", "points": 0, "present": false, "tier": "very_high" }, { "factor": "prior_immunomodulatory_drug_cv_toxicity", "points": 0, "present": false, "tier": "high" }, { "factor": "elevated_bnp", "points": 0, "present": false, "tier": "high" }, { "factor": "prior_anthracycline", "points": 0, "present": false, "tier": "high" }, { "factor": "arrhythmia", "points": 0, "present": false, "tier": "medium_2" }, { "factor": "elevated_troponin", "points": 0, "present": false, "tier": "medium_2" }, { "factor": "left_ventricular_hypertrophy", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "hypertension", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "diabetes", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "hyperlipidemia", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "ckd", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "family_history_thrombophilia", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "prior_thoracic_spine_radiotherapy", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "high_dose_dexamethasone", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "current_or_significant_smoker", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "obesity", "points": 0, "present": false, "tier": "medium_1" }, { "value": 50, "factor": "age_years", "points": 0, "present": false, "tier": "none" }, { "value": 60, "factor": "lvef_percent", "points": 0, "present": false, "tier": "none" } ], "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": "Lyon AR, Dent S, Stanway S, et al.", "doi": "10.1002/ejhf.1920", "id": "lyon-2020", "pmid": "32458582", "source": "Eur J Heart Fail. 2020;22(11):1945-1960", "title": "Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society" }, "formula": "hfa_icos_myeloma", "formula_expression": "very_high if any Very high factor (heart_failure_or_cardiomyopathy, prior_proteasome_inhibitor_cardiotoxicity, venous_thrombosis, cardiac_amyloidosis, arterial_vascular_disease); else high if any High factor (prior_immunomodulatory_drug_cv_toxicity, lvef_percent<50, elevated_bnp, age_years>=75, prior_anthracycline) OR medium_points>=5; else medium if medium_points in 2..4; else low (no factors or one Medium 1). medium_points sums Medium 1 (=1: left_ventricular_hypertrophy, age_years 65-74, hypertension, diabetes, hyperlipidemia, ckd, family_history_thrombophilia, prior_thoracic_spine_radiotherapy, high_dose_dexamethasone, current_or_significant_smoker, obesity) and Medium 2 (=2: lvef_percent 50-54, arrhythmia, elevated_troponin) only. Age and LVEF use the highest matching printed band. Lyon 2020 HFA-ICOS multiple-myeloma therapy table. cardiotoxicity_guide is that paper's expert-opinion guide: low <2%, medium 2-9%, high 10-19%, very high >=20%", "age_years": 50, "cardiotoxicity_guide": "<2%", "lvef_percent": 60, "medium_points": 0, "risk_level": "low" }, { "components": [ { "factor": "heart_failure_or_cardiomyopathy", "points": 0, "present": false, "tier": "very_high" }, { "factor": "prior_proteasome_inhibitor_cardiotoxicity", "points": 0, "present": false, "tier": "very_high" }, { "factor": "venous_thrombosis", "points": 0, "present": false, "tier": "very_high" }, { "factor": "cardiac_amyloidosis", "points": 0, "present": false, "tier": "very_high" }, { "factor": "arterial_vascular_disease", "points": 0, "present": false, "tier": "very_high" }, { "factor": "prior_immunomodulatory_drug_cv_toxicity", "points": 0, "present": false, "tier": "high" }, { "factor": "elevated_bnp", "points": 0, "present": false, "tier": "high" }, { "factor": "prior_anthracycline", "points": 0, "present": false, "tier": "high" }, { "factor": "arrhythmia", "points": 0, "present": false, "tier": "medium_2" }, { "factor": "elevated_troponin", "points": 0, "present": false, "tier": "medium_2" }, { "factor": "left_ventricular_hypertrophy", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "hypertension", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "diabetes", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "hyperlipidemia", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "ckd", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "family_history_thrombophilia", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "prior_thoracic_spine_radiotherapy", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "high_dose_dexamethasone", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "current_or_significant_smoker", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "obesity", "points": 0, "present": false, "tier": "medium_1" }, { "value": 50, "factor": "age_years", "points": 0, "present": false, "tier": "none" }, { "value": 60, "factor": "lvef_percent", "points": 0, "present": false, "tier": "none" } ], "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": "Lyon AR, Dent S, Stanway S, et al.", "doi": "10.1002/ejhf.1920", "id": "lyon-2020", "pmid": "32458582", "source": "Eur J Heart Fail. 2020;22(11):1945-1960", "title": "Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society" }, "formula": "hfa_icos_myeloma", "formula_expression": "very_high if any Very high factor (heart_failure_or_cardiomyopathy, prior_proteasome_inhibitor_cardiotoxicity, venous_thrombosis, cardiac_amyloidosis, arterial_vascular_disease); else high if any High factor (prior_immunomodulatory_drug_cv_toxicity, lvef_percent<50, elevated_bnp, age_years>=75, prior_anthracycline) OR medium_points>=5; else medium if medium_points in 2..4; else low (no factors or one Medium 1). medium_points sums Medium 1 (=1: left_ventricular_hypertrophy, age_years 65-74, hypertension, diabetes, hyperlipidemia, ckd, family_history_thrombophilia, prior_thoracic_spine_radiotherapy, high_dose_dexamethasone, current_or_significant_smoker, obesity) and Medium 2 (=2: lvef_percent 50-54, arrhythmia, elevated_troponin) only. Age and LVEF use the highest matching printed band. Lyon 2020 HFA-ICOS multiple-myeloma therapy table. cardiotoxicity_guide is that paper's expert-opinion guide: low <2%, medium 2-9%, high 10-19%, very high >=20%", "age_years": 50, "cardiotoxicity_guide": "<2%", "lvef_percent": 60, "medium_points": 0, "risk_level": "low" } ] } ``` ## Response fields - `formula` (string): hfa_icos_myeloma - `formula_expression` (string): Lyon 2020 HFA-ICOS multiple-myeloma therapy classification - `age_years` (integer): Age in years used (18-100) - `lvef_percent` (integer): LVEF percent used (10-80) - `medium_points` (integer): Sum of Medium 1 (1) and Medium 2 (2) only - `risk_level` (string): low, medium, high, or very_high (Lyon 2020). Not a treatment order. - `cardiotoxicity_guide` (string): Expert-opinion guide from Lyon 2020: <2%, 2-9%, 10-19%, or >=20%. Not a validated absolute risk. - `components` (array): Per-factor Points rows; High and Very high have 0 medium_points - `citation` (object): Lyon 2020 Eur J Heart Fail citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "heart_failure_or_cardiomyopathy", "points": 0, "present": false, "tier": "very_high" }, { "factor": "prior_proteasome_inhibitor_cardiotoxicity", "points": 0, "present": false, "tier": "very_high" }, { "factor": "venous_thrombosis", "points": 0, "present": false, "tier": "very_high" }, { "factor": "cardiac_amyloidosis", "points": 0, "present": false, "tier": "very_high" }, { "factor": "arterial_vascular_disease", "points": 0, "present": false, "tier": "very_high" }, { "factor": "prior_immunomodulatory_drug_cv_toxicity", "points": 0, "present": false, "tier": "high" }, { "factor": "elevated_bnp", "points": 0, "present": false, "tier": "high" }, { "factor": "prior_anthracycline", "points": 0, "present": false, "tier": "high" }, { "factor": "arrhythmia", "points": 0, "present": false, "tier": "medium_2" }, { "factor": "elevated_troponin", "points": 0, "present": false, "tier": "medium_2" }, { "factor": "left_ventricular_hypertrophy", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "hypertension", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "diabetes", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "hyperlipidemia", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "ckd", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "family_history_thrombophilia", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "prior_thoracic_spine_radiotherapy", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "high_dose_dexamethasone", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "current_or_significant_smoker", "points": 0, "present": false, "tier": "medium_1" }, { "factor": "obesity", "points": 0, "present": false, "tier": "medium_1" }, { "value": 50, "factor": "age_years", "points": 0, "present": false, "tier": "none" }, { "value": 60, "factor": "lvef_percent", "points": 0, "present": false, "tier": "none" } ], "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": "Lyon AR, Dent S, Stanway S, et al.", "doi": "10.1002/ejhf.1920", "id": "lyon-2020", "pmid": "32458582", "source": "Eur J Heart Fail. 2020;22(11):1945-1960", "title": "Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society" }, "formula": "hfa_icos_myeloma", "formula_expression": "very_high if any Very high factor (heart_failure_or_cardiomyopathy, prior_proteasome_inhibitor_cardiotoxicity, venous_thrombosis, cardiac_amyloidosis, arterial_vascular_disease); else high if any High factor (prior_immunomodulatory_drug_cv_toxicity, lvef_percent<50, elevated_bnp, age_years>=75, prior_anthracycline) OR medium_points>=5; else medium if medium_points in 2..4; else low (no factors or one Medium 1). medium_points sums Medium 1 (=1: left_ventricular_hypertrophy, age_years 65-74, hypertension, diabetes, hyperlipidemia, ckd, family_history_thrombophilia, prior_thoracic_spine_radiotherapy, high_dose_dexamethasone, current_or_significant_smoker, obesity) and Medium 2 (=2: lvef_percent 50-54, arrhythmia, elevated_troponin) only. Age and LVEF use the highest matching printed band. Lyon 2020 HFA-ICOS multiple-myeloma therapy table. cardiotoxicity_guide is that paper's expert-opinion guide: low <2%, medium 2-9%, high 10-19%, very high >=20%", "age_years": 50, "cardiotoxicity_guide": "<2%", "lvef_percent": 60, "medium_points": 0, "risk_level": "low" } ``` ## Errors - HTTP 400 `invalid_hfa_icos_myeloma`: Lyon 2020 HFA-ICOS multiple-myeloma therapy inputs must match that table's age, LVEF, and yes/no factors. 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 ## Related tools - [HFA-ICOS anthracycline baseline CV risk](https://magentlab.com/docs/hfa-icos-anthracycline) — Apply the Lyon 2020 HFA-ICOS anthracycline baseline cardiovascular risk proforma from caller-assigned age, LVEF, and published Very high, High, Medium 2, and Medium 1 factors. Returns risk_level, medium_points, and the paper's expert-opinion cardiotoxicity_guide. - [HFA-ICOS HER2](https://magentlab.com/docs/hfa-icos-her2) — Classify Lyon 2020 HFA-ICOS baseline cardiovascular risk before HER2-targeted therapy and return low, medium, high, or very high with the expert-opinion cardiotoxicity guide. - [HFA-ICOS VEGF-inhibitor baseline CV risk](https://magentlab.com/docs/hfa-icos-vegf) — Classify Lyon 2020 HFA-ICOS baseline cardiovascular risk for someone scheduled to receive VEGF inhibitors or VEGF TKIs, using that table's very-high, High, Medium 2, and Medium 1 rows. - [HFA-ICOS RAF-MEK inhibitor baseline CV risk](https://magentlab.com/docs/hfa-icos-raf-mek) — Classify Lyon 2020 HFA-ICOS baseline cardiovascular risk before combination RAF and MEK inhibitors as very_high, high, medium, or low from that table's printed factors and the shared medium-point rule. - [HFA-ICOS BCR-ABL TKI baseline CV risk](https://magentlab.com/docs/hfa-icos-bcr-abl) — Classify published HFA-ICOS baseline cardiovascular risk before second- or third-generation multi-targeted kinase inhibitors for CML targeting BCR-ABL. ## 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.