Risk scores: Are these tools imperfect, or merely complex to use?

Developing therapeutic strategies guided by multiparametric criteria that go beyond merely clinical factors is a complex undertaking that in some cases fails to achieve its main objective, which is the identification of patient groups.The task is particularly important when the aim is to define risk groups.Risk scores and risk tables are used extensively in cardiology to identify patients who have a better or worse prognosis for a given clinical condition at the time of observation and, on the basis of this classification, to decide on the appropriate treatment.A higher risk score often leads to a more aggressive approach, in an attempt to improve the initial prognosis.Cardiac surgery also uses risk scores, but for a different purpose: they are mainly used to predict the mortality associated with a particular surgical intervention to be expected for a patient's specific clinical and anatomical characteristics.There are many cases when there is clearly a need for a surgical intervention, but the patient does not fulfill the conditions for it to be performed safely.The indication is there, but not the conditions.