AUB‐HAS2 Cardiovascular Risk Index: Performance in Surgical Subpopulations and Comparison to the Revised Cardiac Risk Index

Abstract

Background The American University of Beirut ( AUB )‐ HAS 2 Cardiovascular Risk Index is a newly derived index for preoperative cardiovascular evaluation. It is based on 6 data elements: history of heart disease; symptoms of angina or dyspnea; age ≥75 years; hemoglobin <12 mg/ dL ; vascular surgery; and emergency surgery. In this study we analyze the performance of this new index and compare it with that of the Revised Cardiac Risk Index in a broad spectrum of surgical subpopulations. Methods and Results The study population consisted of 1 167 278 noncardiac surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database. Each patient was given an AUB ‐ HAS 2 score of 0, 1, 2, 3, or >3, depending on the number of data elements present. The performance of the AUB ‐ HAS 2 index was studied in 9 surgical specialty groups and in 8 commonly performed site‐specific surgeries. Receiver operating characteristic curves were constructed for the AUB ‐ HAS 2 and Revised Cardiac Risk Index measures, and the areas under the curve were compared. The outcome measure was death, myocardial infarction, or stroke at 30 days after surgery. The AUB ‐ HAS 2 score was able to stratify risk in all surgical subgroups ( P <0.001). In the majority of surgeries, patients with an AUB ‐ HAS 2 score of 0 had an event rate of <0.5%. The performance of the AUB ‐ HAS 2 index was superior to that of the Revised Cardiac Risk Index in all surgical subgroups ( P <0.001). Conclusions This study extends the validation of the AUB ‐ HAS 2 index to a broad spectrum of surgical subpopulations and demonstrates its superior discriminatory power compared with the commonly utilized Revised Cardiac Risk Index.

Major adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index

“… 11 , 12 Preoperative estimation of patient cardiac risk is possible through the utilization of established universal surgical risk models, such as the revised cardiac risk index (RCRI), NSQIP-MICA index, and the recently published AUB-HAS2 cardiovascular risk index. 13 – 16 However, the development of a procedure-specific risk index for PN, a procedure with relatively low morbidity and a select patient population, carries substantial merit as it enables better optimization of preoperative patient status and improved patient selection for PN versus alternative treatment modalities, such as surveillance or ablative therapy.…”

Performance of the AUB-HAS2 Cardiovascular Risk Index in vascular surgery patients

“…Table 1 lists the most commonly used of these indices. 1,2,[7][8][9][10][11][12][13][14] We have recently reported a new risk index that is simple to acquire and has a powerful discriminatory ability to predict cardiovascular events post-noncardiac surgery. [10][11][12] The AUB-HAS2 cardiovascular risk index was derived from a prospectively enrolled cohort of 3284 patients undergoing noncardiac surgery at the American University of Beirut (AUB) and it was validated in the large American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.…”

“…1,2,[7][8][9][10][11][12][13][14] We have recently reported a new risk index that is simple to acquire and has a powerful discriminatory ability to predict cardiovascular events post-noncardiac surgery. [10][11][12] The AUB-HAS2 cardiovascular risk index was derived from a prospectively enrolled cohort of 3284 patients undergoing noncardiac surgery at the American University of Beirut (AUB) and it was validated in the large American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. 15 It is based on six easily acquired data elements: history of Heart disease, symptoms of Heart disease (angina or dyspnea), Age ⩾ 75 years, Anemia (hemoglobin < 12 mg/dL), emergency Surgery, and vascular Surgery.…”

Update in perioperative cardiac medicine 2021

“…Additionally, it identifi ed a large low-risk group of patients (score = 0) and a high-risk group (score ≥ 3) with complication rates less than 1% and more than 10%, respectively. 4 Of note, there were differences between the AUB-HAS2 and Revised Cardiac Risk Index, limiting a true direct comparison but potentially enhancing applicability towards the overall population undergoing noncardiac surgery. The former included emergency surgery as well as some low-risk procedures, and the outcomes studied included stroke and allcause mortality at 30 days, which were not included in the Revised Cardiac Risk Index.…”

“…The former included emergency surgery as well as some low-risk procedures, and the outcomes studied included stroke and allcause mortality at 30 days, which were not included in the Revised Cardiac Risk Index. 4 The Updated Cardiac Risk Score Scorcu et al 5 The areas under the curve were higher for the UCRS than the Revised Cardiac Risk Index in both the derivation cohort (0.86 vs 0.79) and the validation cohort (0.77 vs 0.72). This study evaluated a wider range of complications than did the Revised Cardiac Risk Index, but like the Revised Cardiac Risk Index, it was a single-institution study and used creatine kinase-MB, not troponin, for postoperative surveillance.…”