Norton Admission Scale as a Prognostic Factor Among Acute Heart Failure Patients

Background: The Norton scale scoring system was created in 1962 assessing the frailty hospitalized patients, and is still being used nowadays by nurses evaluating patients at hospital admission. Accordingly, this scale may be an important predictor of outcome following hospitalization We hypothesized that a low Norton score is an independent predictor of long-term mortality among hospitalized acute heart failure patients.

Methods: of the present study population comprised 4388 acute heart failure patients presenting to Sheba medical center between the years 2008-2016, and were followed-up for long-term mortality and HF hospitalization following discharge cohort was divided according to the Norton score, low score (<16) and high score (>=16). Multivariate Cox proportional hazards regression modeling was used to assess the independent association between Norton score and long-term mortality.

Results: Patients with low score (n=1611 [37%]) were older, had higher prevalence of co-morbidities such as hypertension, COPD, anemia, CVA and renal failure compared to high score (n=3323) (p<0.05 for each). Kaplan-Meir survival analysis (Figure) showed that at 1-year of follow-up mortality rates were significantly higher among patients with a low Norton score (34%) as compared with those with a high score (15%; p<0.001 for the overall difference during follow-up). After adjustment for confounders and comorbidities, multivariate analysis showed that a low Norton score was associated with >2-fold increased risk of all-cause mortality at 1 and 5 years of follow-up following hospitalization (p<0.001 for both). The association between Norton and mortality was consistent in both the HFrEF and HFpEF subgroups (p-value for interaction < 0.10).

Conclusion: Our findings, from a large cohort of hospitalized heart failure patients, show that the Norton score at admission is powerful independent predictor of long-term mortality. These data suggest that the scale should be added as an important risk stratification parameter in this high-risk population.