A simple points system may soon help guide treatment of elderly heart failure patients. Researchers at Washington University School of Medicine in St. Louis found that by counting how many of seven easy-to-obtain health factors a patient has, physicians can estimate the patient's risk of dying.

The points system may steer doctors toward considering more aggressive treatments such as implantable defibrillators and pacemakers for those at low risk of death. However, elderly patients with a high risk may want to avoid stressful and unnecessary medical intervention and may benefit most from palliative or hospice care.

"It has typically been very difficult to predict how long a person hospitalized with heart failure may survive," says senior author Michael W. Rich, M.D., associate professor of medicine and a geriatric cardiologist at Barnes-Jewish Hospital. "That has made it hard for the treating physician to know how aggressive to be with therapy."

Heart failure afflicts about 5 million people in the United States, hospitalizing more than a million patients each year. The incidence of heart failure increases with age, and with people 65 and older becoming the fastest growing segment of the population, the personal and financial burden of heart failure will likely increase.

In their study, which followed 282 elderly heart failure patients for up to 14 years, the researchers identified seven factors that most affect patient survival:

• advanced age
• a history of dementia (contributes to a host of conditions related to the inability to properly care for oneself)
• coronary artery disease (arteries that supply blood to the heart muscle are hardened and narrowed)
• peripheral vascular disease (similar to coronary artery disease but involving blood vessels outside of the heart and brain)
• low sodium in the blood (an indication of neurohormonal imbalance)
• high urea in the blood (a reflectio
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