Rules for using the SCORE scale
The SCORE scale and its modern modification SCORE2 are used at the end of the first stage of the health check-up (dispensarization). The tool is designed exclusively for people aged 40 to 65 years who have no clinical manifestations of atherosclerotic disease and no diagnosed diabetes mellitus.
The primary task of the physician when calculating risk is not simply to frighten the patient with high numbers, but to visually demonstrate the probability of myocardial infarction or stroke if their current lifestyle is maintained (alcohol consumption, smoking, high cholesterol concentration, low physical activity). This is essential for strong motivation to correct risk factors.
The scale must strictly not be used in two situations:
- Patients over 65 years old. In their health check-up charts (Form 131), the SCORE table is not used, as such patients are automatically assigned the status of "very high risk".
- Individuals with a history of myocardial infarction. In these patients, a cardiovascular event has already occurred, so assessing the probability of its primary onset is meaningless. According to the modified European scale, they fall into the bottom row — stage 3 (symptomatic cardiovascular disease). Regardless of their blood pressure level (even with high-normal BP), their total and additional risk is always considered very high.
SCORE risk grading
The classical cardiovascular risk grading using the SCORE scale identifies four categories depending on the probability of a fatal event:
| Probability (%) | Risk category |
|---|---|
| < 1% | Low |
| 1–4% | Moderate |
| 5–9% | High |
| ≥ 10% | Very high |
In the modified version (SCORE2), slightly different threshold values are used: low risk is less than 2.5%, moderate is from 2.5% to 5%, high is from 5% to 10%, and very high is greater than 10%.
Baseline and additional risk
When examining patients with already developed arterial hypertension (AH), it is necessary to distinguish between two concepts:
- Baseline risk is the initial assessment of total cardiovascular risk characteristic of the patient at the time of diagnosis.
- Additional risk is stratification performed when target organ damage is already reliably known or a cardiovascular disease diagnosis has been established.
The main difference is that the SCORE scale assesses the probabilistic total risk of fatal events in initially healthy individuals. At the same time, the additional risk table is used in the presence of existing pathology (AH, target organ damage). Additional risk is always more accurate and prognostically serious because it is based on the fact of already initiated structural destruction of organs.
Alternative risk stratification scales
For age groups and clinical situations that do not fall under the SCORE criteria, other stratification tools are used:
- Relative risk scale. Used at the first stage of the health check-up for young people aged 18 to 40 years. The assessment is based on three parameters: smoking status, total cholesterol level, and systolic BP. Age is not taken into account in this scale.
- SYNTAX score. Intended for patients with left main coronary artery (LMCA) disease and/or multivessel coronary artery disease. The goal of the scale is to assess the severity of anatomical lesions and predict the risk of death or long-term cardiovascular complications (ESC class of recommendations IIb B, level of reliability of evidence C, level of reliability of data 3).
- EuroSCORE II. A specific scale recommended by cardiologists to predict in-hospital mortality in severe patients (ESC class of recommendations IB, level of reliability of evidence B, level of reliability of data 1).
It is easy to remember the 5 parameters of the SCORE scale on the fingers of one hand: Sex, Age, Smoking, Systolic BP, Total cholesterol.
Class and exam questions
Why is the SCORE scale not used in patients after a myocardial infarction?
Because a cardiovascular event has already occurred in them. Such patients automatically belong to the very high-risk group (stage 3 according to the modified European scale) regardless of their BP level.
How to assess risk in patients over 65 years old?
In individuals over 65 years old, the SCORE scale is not used. As part of the health check-up (Form 131), they are automatically assigned "very high risk".
How does the SCORE scale differ from the assessment of additional risk?
SCORE predicts the total risk of fatal events in initially healthy people. Additional risk is assessed when a diagnosis of AH is already established or target organ damage is present.
What else to study on this topic
- Criteria for target organ damage in arterial hypertension
- Differences between the classical SCORE scale and its modification SCORE2
- Anatomical assessment of the coronary bed using the SYNTAX score
- Clinical application of the EuroSCORE II scale in the inpatient setting
- Features of relative risk assessment in patients under 40 years old
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