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Cardiac Anesthesia Risk Evaluation (CARE) Scale

Purpose: To evaluate a patient having cardiac surgery using the Cardiac Anesthesia Risk Evaluation (CARE) score.

Description

The Cardiac Anesthesia Risk Evaluation Scale (CARE Score) is a simple risk classification system for patients undergoing cardiac surgery. This can rapidly stratify a patient for the probability of morbidity and mortality. The authors are from the University of Ottawa Heart Institute in Canada.


Parameters:

(1) cardiac disease status

(2) medical disease status

(3) cardiac surgery planned

(4) urgency of surgery

 

Parameter

Status

Group

cardiac disease

stable

A1

 

uncontrolled

A2

 

advanced (end stage)

A3

medical diseases

none

B1

 

1 or more controlled

B2

 

1 or more uncontrolled

B3

cardiac surgery

noncomplex

C1

 

complex

C2

 

undertaken as last hope to save or improve life

C3

urgency of surgery

not emergency

D1

 

emergency (surgery performed as soon as diagnosis is made and an OR is available)

D2

 

Controlled medical problems include:

(1) controlled hypertension

(2) controlled diabetes mellitus

(3) controlled peripheral vascular disease

(4) controlled chronic obstructive pulmonary disease

(5) controlled systemic disease

 

Uncontrolled cardiac or medical problems include:

(1) unstable angina pectoris treated with intravenous heparin or nitroglycerin

(2) preoperative intra-aortic balloon pump

(3) heart failure with pulmonary or peripheral edema

(4) uncontrolled hypertension

(5) renal insufficiency (serum creatinine > 140µmol/L

(6)  other debilitating systemic disease

 

Complex surgery includes:

(1) reoperation

(2) combined valve and coronary artery surgery

(3) multiple valve surgery

(4) left ventricular aneurysmectomy

(5) repair of ventricular septal defect (VSD) after myocardial infarction

(6) coronary artery bypass of diffuse or heavily calcified vessels

 

Situation

Score

Risk Category

A1 AND B1 AND C1

1

1

A1 AND B2 AND C1

2

2

(A2 OR B3 OR C2) AND D1

3

3

(A2 OR B3 OR C2) AND D2

3E

4

(A2 OR A3 OR B3) AND C2 AND D1

4

5

(A2 OR A3 OR B3) AND C2 AND D2

4E

6

A3 AND C3 AND D1

5

7

A3 AND C3 AND D2

5E

8

 

 

Risk Category

Morbidity

Prolonged Length of Stay

Mortality

1

5.4% (4.3-6.8)

2.9% (2.2-3.9)

0.5% (0.3-0.9)

2

10.3% (8.9-12.1)

5.1% (4.2-6.3)

1.1% (0.7-1.7)

3

19% (17.2-20.9)

8.8% (7.6-10.2)

2.2% (1.6-3.1)

4

32.1% (29.3-35.0)

14.7% (12.8-16.8)

4.5% (3.5-5.7)

5

48.8% (44.1-53.6)

23.5% (20.1-27.3)

8.8% (6.9-11.3)

6

65.8% (59.5-71.6)

35.4% (29.3-42.0)

16.7% (12.4-22.1)

7

79.6% (73.2-84.7)

49.4% (40.4-58.5)

29.3% (20.8-39.6)

8

88.7% (83.5-92.5)

63.6% (52.5-73.4)

46.2% (32.4-60.5)

after Table 4, page 200

 

Performance:

• predicted morbidity Area Under Curve by ROC Analysis: 0.721 +/- 0.014

• predicted mortality Area Under Curve by ROC Analysis: 0.801 +/- 0.027

• These values compared favorably to the Parsonnet, Tu and Truman scores (see Chapter 6 on Cardiology).


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Specialty

Objective

ICD-10