ACTION_ICU_score v.1

ACTION ICU Score for Intensive Care in NSTEMI helps to predict the likelihood of complications requiring ICU care among patinets with NSTEMI (Non-ST elevated Myocardial Infarction). Formula: ACTION ICU Score is calculated by adding the following points: - Age: <70 years: 0p, ≥70 years: 1p - Serum cratinine level, mg/dl: <1.1: 0p, ≥1.1: 1p - Heart rate, bpm: <85: 0p, 85-100: 1p, ≥100: 3p - Systolic blood pressure, mmHg, ≥145: 0p, 125-145: 1p, <125: 3p - Initial troponin: if 12 times above upper limit of normal: 2p, otherwise: 0p - Heart failure signs or symptoms: No: 0p, Yes: 5p - ST depression on ECG: No: 0p, Yes: 1p - Prior revascularization: Yes: 0p, No: 1p - Chronic lung disease: No: 0p, Yes: 2p ACTION ICU Score can be interpreted as follows: ACTION ICU Score Risk of complications requiring ICU care among initially uncomplicated patients with NSTEMI* ≤1 3.4% 2 4.9% 3 5.5% 4 6.9% 5 9.3% 6 12% 7 14.6% 8 17.4% 9 20.8% 10 23.3% 11 27.7% 12 31% 13 31.5% 14 39.3% >14 >39.3% *Cardiac arrest, shock, high-grade atrioventricular block, respiratory failure, stroke, or death during index admission.

Daniel Keszthelyi

models@cambiocds.com

Cambio Healthcare Services

To help to identify NSTEMI patients who are initially stable but may later develop complications requiring a higher level of care, and may therefore help with disposition and avoiding failure to rescue. ACTION ICU Score for Intensive Care in NSTEMI helps to predict the likelihood of complications requiring ICU care for patients with NSTEMI among patinets with NSTEMI.

Note: ACTION ICU Score is not yet prospectively validated. ACTION ICU Score helps to predict the risk of NSTEMI complications and thus identifying patients who are initially stable but may later develop complications requiring a higher level of care, and may therefore help with disposition and avoiding failure to rescue.

Should not be used in patients with STEMI, cardiogenic shock, myocarditis, or cardiac arrest. Do not use for patients under 65 years as it is derived in patients ≥65 years old, and may not apply to younger patients. Note that different institutions may use different thresholds for ICU admission.

[1] Fanaroff AC, Chen AY, Thomas LE, et al. Risk Score to Predict Need for Intensive Care in Initially Hemodynamically Stable Adults With Non-ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc. 2018;7(11). [2] Chin CT, Chen AY, Wang TY, et al. Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the acute coronary treatment and intervention outcomes network (ACTION) registry-get with the guidelines (GWTG) acute myocardial infarction mortality model and risk score. Am Heart J. 2011;161(1):113-122.e2. [3] National Clinical Guidelines Centre (UK). Stable Angina: Methods, Evidence & Guidance [Internet]. London: Royal College of Physicians (UK); 2011 Jul. (NICE Clinical Guidelines, No. 126.) 14, Risk scores. Available from: https://www.ncbi.nlm.nih.gov/books/NBK83609/. [4] Fanaroff AC, Peterson ED, Chen AY, et al. Intensive Care Unit Utilization and Mortality Among Medicare Patients Hospitalized with Non-ST-Segment Elevation Myocardial Infarction. JAMA Cardiol. 2017;2(1):36-44.

OBSERVATION.basic_demographic.v1, OBSERVATION.lab_test_creatinine.v1, OBSERVATION.pulse.v2, OBSERVATION.blood_pressure.v2, OBSERVATION.action_icu_score.v0