The Cardio-Pal Score – A Novel Prognostication Tool for 6-Month Mortality in Heart Failure Inpatients

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart Failure (inpatients) (n=2544). Intervention: CARDIO-PAL prognostic score vs. Low/intermediate-risk CARDIO-PAL groups or PPSv2 alone. Primary outcome: 6-month mortality post-hospital discharge (AUC 0.80, 95% CI 0.75-0.84).

Q: What does this research mean for the field?

The CARDIO-PAL score predicts 6-month mortality in heart failure inpatients with good discrimination (AUC 0.80), stratifying patients into low (2%), intermediate (15%), and high (54%) mortality risk groups. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hilary J. Bews; James Tam; Samuel Quan; Casandra Dolovich; Klara Whalen; Sarah-Jane Beaudry; S. Butterworth; A. Southam; Jana L. Pilkey

doi:10.64898/2026.09.28.26364242

October 1, 2026Open Access

The Cardio-Pal Score – A Novel Prognostication Tool for 6-Month Mortality in Heart Failure Inpatients

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Key result

CARDIO-PAL score predicts 6-month heart failure mortality with ~0.80 AUC, stratifying risk up to 54%.

AUC 0.80
95% CI 0.75-0.84
n=2,544

Why the study?

Available prognostic tools in heart failure commonly predict survival beyond 1-year, limiting goals of care discussions and palliative care enrollment. A novel prognostic score was needed to better predict 6-month mortality in heart failure inpatients.

Does the novel CARDIO-PAL prognostic score accurately predict 6-month mortality following hospital discharge in adult heart failure inpatients?

Key Points

To develop and validate a novel clinical prognostication score that predicts 6-month mortality in hospitalized patients with heart failure.
Identified patients with heart failure admitted to St. Boniface Hospital between January 1, 2019, and January 1, 2024 (N=2544), randomly divided into development (n=2036, 80%) and holdout validation (n=508, 20%) cohorts.
Collected baseline patient characteristics, imaging parameters, laboratory values, and Palliative Performance Scale (PPSv2) functional scores.
Applied penalized LASSO regression to select variables most predictive of 6-month mortality in the development cohort and incorporated retained variables into a multivariable logistic regression model.
Six-month mortality was 29% in the development cohort and 31% in the validation cohort.
Eight candidate variables were retained: age (aOR 1.01), admission PPSv2 per 10% decrease from 80% (aOR 2.08, 95% CI 1.88–2.23), triage systolic blood pressure per 10 mmHg decrease from 130 mmHg (aOR 1.14, 95% CI 1.09–1.19), right ventricular systolic pressure (aOR 2.06, 95% CI 1.41–3.01), urea (aOR 2.13, 95% CI 1.73–2.61), and discontinued use of ACEi/ARB (aOR 2.58, 95% CI 1.86–3.57), beta-blocker (aOR 1.59, 95% CI 1.04–2.42), and MRA (aOR 2.67, 95% CI 1.54–4.62).
In the validation cohort, the CARDIO-PAL score demonstrated an area under the curve of 0.80 (95% CI 0.75–0.84) with a calibration slope of 0.84 and intercept of -0.04; observed 6-month mortality was 2% in the low-risk group, 15% in the intermediate-risk group, and 54% in the high-risk group.

Study Design

Type

Cohort (n=2,544)

Multicenter

No

Structured PICO

Does the novel CARDIO-PAL prognostic score accurately predict 6-month mortality following hospital discharge in adult heart failure inpatients?

P

Population

2,544 hospitalized adults (mean age 74 years, 43.7% female) with a primary diagnosis of heart failure, excluding those with LVAD or recent heart transplant, followed for 6-month post-discharge mortality.

E

Exposure

CARDIO-PAL prognostic risk score (incorporating age, Palliative Performance Scale version 2 [PPSv2], systolic blood pressure, discontinued or current use of ACEi/ARB, beta-blocker, and MRA, right ventricular systolic pressure [RVSP], and urea; plus a reduced model version excluding RVSP)

C

Comparator

Original Palliative Performance Scale version 2 (PPSv2 ≤ 40% threshold)

O

Outcome

Short-term all-cause mortality, defined as death occurring within 6 months of hospital dischargehard clinical

Main Result

Effect estimate: AUC 0.80 (95% CI 0.75-0.84)

Absolute Event Rate: 54% vs 2%

The CARDIO-PAL score provides a practical, well-calibrated tool combining clinical, laboratory, medication, and functional parameters (PPSv2) to predict 6-month mortality in hospitalized heart failure patients, facilitating timely palliative care and hospice referrals.

Limitations

Single-center retrospective cohort design
Substantial missingness (>25%) in several candidate laboratory and echocardiographic variables (NT-proBNP, ALT, GGT, RVSP) requiring single imputation
Discharge laboratory variables had up to 75% missingness and were excluded from the final model
Substantial missingness (>25%) in four candidate variables (NT-proBNP, ALT, GGT, RVSP) and up to 75% missingness in discharge laboratory variables
Single-center retrospective design at St. Boniface Hospital in Winnipeg, Canada
NT-proBNP was only universally available after 2020 in the study center

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Implication

May support short-term palliative planning in HF inpatients; leaves open external validation before clinical adoption.

Abstract

Background Patients with heart failure (HF) experience high mortality, yet survival estimates remain challenging. Available prognostic tools commonly predict survival beyond 1-year, limiting goals of care discussions and enrollment on palliative care programs. The objective of this project was to develop a novel prognostic score to better predict 6-month mortality. Methods Patients with HF admitted to the St. Boniface Hospital (Winnipeg, Canada) between January 1, 2019 and January 1, 2024 were identified. Patient characteristics, imaging parameters, laboratory values, and functional assessments (Palliative Performance Scale; PPSv2) were collected. Patients were randomly divided into development (80%) and validation (20%) cohorts. Penalized LASSO regression was used to select variables most predictive of 6-month mortality in the development cohort. Retained variables were incorporated into a multivariable logistic regression model to derive the CARDIO-PAL score, the performance of which was assessed in the holdout validation cohort. Results Characteristics were similar between the development (n = 2036) and validation (n = 508) cohorts, with 6-month mortality rates of 29% and 31%, respectively. 8 candidate variables were retained: age (adjusted odds ratio [aOR] 1.01), PPSv2 (aOR 2.08), systolic blood pressure (aOR 1.14), discontinued use of angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (aOR 2.58), beta-blocker (aOR 1.59), and mineralocorticoid receptor antagonist (aOR 2.67), right ventricular systolic pressure (aOR 2.06), and urea (aOR 2.13). The CARDIO- PAL score demonstrated good discrimination, with an area under the curve of 0.80 (95% confidence interval 0.75 – 0.84) and good calibration (slope 0.84, intercept -0.04). 6-month mortality across low, intermediate, and high-risk groups was 2%, 15%, and 54%, respectively. Conclusion The CARDIO-PAL score is a novel tool to predict 6-month mortality in HF inpatients. A collaborative approach integrating CARDIO-PAL with other prognostic scores and serial clinical assessments has the potential to promote patient-centered care and improve referral to palliative care programs.

Discussion

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Cite This Study

Bews et al. (2026) conducted a cohort in Heart Failure (inpatients) (n=2,544). CARDIO-PAL prognostic score vs. Low/intermediate-risk CARDIO-PAL groups or PPSv2 alone was evaluated on 6-month mortality post-hospital discharge (AUC 0.80, 95% CI 0.75-0.84). The CARDIO-PAL score predicted 6-month mortality in heart failure inpatients with an AUC of 0.80 (95% CI 0.75-0.84), stratifying risk into 2% (low), 15% (intermediate), and 54% (high).

synapsesocial.com/papers/6ae28e0ecbadf70daf6c3fe1 https://doi.org/10.64898/2026.09.28.26364242

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The Cardio-Pal Score – A Novel Prognostication Tool for 6-Month Mortality in Heart Failure Inpatients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The Cardio-Pal Score – A Novel Prognostication Tool for 6-Month Mortality in Heart Failure Inpatients

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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