HEARTLAND Protocol

HEARTLAND Protocol FHIR Implementation Guide
0.3.0 - United States of America flag

HEARTLAND FHIR candidate 0.3.0 — draft, experimental R4 4.0.1 reference. Prepared for technical review; not evidence of clinical validation or vendor interoperability.

Resource Profile: HEARTLAND Risk Assessment ( Experimental )

Official URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-assessment Version: 0.3.0
Draft as of 2026-09-29 Computable Name: HeartlandRiskAssessment

Heart failure risk stratification per the HEARTLAND Protocol v3.2 risk score. The score sums up to 18 points across ten weighted criteria and maps to three qualitative tiers: low (0-4), moderate (5-8), high (>=9). It is a non-validated implementation heuristic that assigns monitoring intensity; it does not predict an outcome and has not been validated against outcome data. For the complete Boolean capture contract use HeartlandRiskInputResponse. Legacy Observation and generic QuestionnaireResponse basis references remain allowed for compatibility; this profile alone does not validate their content or recompute the total. The tier travels in prediction.qualitativeRisk and the point total in the heartland-risk-score-total extension; probability[x] is prohibited, because a point count is not a likelihood of an outcome.

Usages:

You can also check for usages in the FHIR IG Statistics

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots, and their representations.

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. RiskAssessment 0..* RiskAssessment Potential outcomes for a subject with likelihood
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): The status of the risk assessment; e.g. preliminary, final, amended, etc.
.... text Σ 1..1 string Plain text representation of the concept
Required Pattern: HEARTLAND Protocol v3.2 Risk Score
... subject SΣ 1..1 Reference(HEARTLAND Patient | Patient) Who/what does assessment apply to?
... basis S 1..* Reference(QuestionnaireResponse | Observation) Information used in assessment
... prediction SC 1..1 BackboneElement Outcome predicted
Constraints: ras-2
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:scoreTotal S 0..1 integer Total HEARTLAND risk score (0-18 heuristic points, not a probability)
URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-score-total
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... qualitativeRisk S 1..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: HEARTLAND Risk Tier Value Set (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
RiskAssessment.status Base required ObservationStatus 📍4.0.1 FHIR Std.
RiskAssessment.method Base example Not State Unknown
RiskAssessment.prediction.​qualitativeRisk Base required HEARTLAND Risk Tier Value Set 📦0.3.0 This IG

Constraints

Id Grade Path(s) Description Expression

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. RiskAssessment 0..* RiskAssessment Potential outcomes for a subject with likelihood
... status S 1..1 code registered | preliminary | final | amended +
... method S 1..1 CodeableConcept Evaluation mechanism
.... text 1..1 string Plain text representation of the concept
Required Pattern: HEARTLAND Protocol v3.2 Risk Score
... subject S 1..1 Reference(HEARTLAND Patient | Patient) Who/what does assessment apply to?
... prediction S 1..1 BackboneElement Outcome predicted
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:scoreTotal S 0..1 integer Total HEARTLAND risk score (0-18 heuristic points, not a probability)
URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-score-total
.... probability[x] 0..0 Likelihood of specified outcome
.... qualitativeRisk S 1..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: HEARTLAND Risk Tier Value Set (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
RiskAssessment.prediction.​qualitativeRisk Base required HEARTLAND Risk Tier Value Set 📦0.3.0 This IG
NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. RiskAssessment 0..* RiskAssessment Potential outcomes for a subject with likelihood
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Unique identifier for the assessment
... basedOn 0..1 Reference(Resource) Request fulfilled by this assessment
... parent 0..1 Reference(Resource) Part of this occurrence
... status SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): The status of the risk assessment; e.g. preliminary, final, amended, etc.
... method SΣ 1..1 CodeableConcept Evaluation mechanism
Binding Description: (example): The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
.... text Σ 1..1 string Plain text representation of the concept
Required Pattern: HEARTLAND Protocol v3.2 Risk Score
... code Σ 0..1 CodeableConcept Type of assessment
... subject SΣ 1..1 Reference(HEARTLAND Patient | Patient) Who/what does assessment apply to?
... encounter Σ 0..1 Reference(Encounter) Where was assessment performed?
... occurrence[x] Σ 0..1 When was assessment made?
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
... condition Σ 0..1 Reference(Condition) Condition assessed
... performer Σ 0..1 Reference(Practitioner | PractitionerRole | Device) Who did assessment?
... reasonCode 0..* CodeableConcept Why the assessment was necessary?
... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why the assessment was necessary?
... basis S 1..* Reference(QuestionnaireResponse | Observation) Information used in assessment
... prediction SC 1..1 BackboneElement Outcome predicted
Constraints: ras-2
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:scoreTotal S 0..1 integer Total HEARTLAND risk score (0-18 heuristic points, not a probability)
URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-score-total
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... outcome 0..1 CodeableConcept Possible outcome for the subject
Binding Description: (example): The condition or other outcome; e.g. death, remission, amputation, infection, etc.
.... qualitativeRisk S 1..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: HEARTLAND Risk Tier Value Set (required)
.... relativeRisk 0..1 decimal Relative likelihood
.... when[x] 0..1 Timeframe or age range
..... whenPeriod Period
..... whenRange Range
.... rationale 0..1 string Explanation of prediction
... mitigation 0..1 string How to reduce risk
... note 0..* Annotation Comments on the risk assessment

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
RiskAssessment.language Base preferred Common Languages 📍4.0.1 FHIR Std.
RiskAssessment.status Base required ObservationStatus 📍4.0.1 FHIR Std.
RiskAssessment.method Base example Not State Unknown
RiskAssessment.prediction.​outcome Base example Not State Unknown
RiskAssessment.prediction.​qualitativeRisk Base required HEARTLAND Risk Tier Value Set 📦0.3.0 This IG

Constraints

Id Grade Path(s) Description Expression

Summary

Mandatory: 5 elements
Must-Support: 7 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

Key Elements View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. RiskAssessment 0..* RiskAssessment Potential outcomes for a subject with likelihood
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... status SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): The status of the risk assessment; e.g. preliminary, final, amended, etc.
.... text Σ 1..1 string Plain text representation of the concept
Required Pattern: HEARTLAND Protocol v3.2 Risk Score
... subject SΣ 1..1 Reference(HEARTLAND Patient | Patient) Who/what does assessment apply to?
... basis S 1..* Reference(QuestionnaireResponse | Observation) Information used in assessment
... prediction SC 1..1 BackboneElement Outcome predicted
Constraints: ras-2
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:scoreTotal S 0..1 integer Total HEARTLAND risk score (0-18 heuristic points, not a probability)
URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-score-total
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... qualitativeRisk S 1..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: HEARTLAND Risk Tier Value Set (required)

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
RiskAssessment.status Base required ObservationStatus 📍4.0.1 FHIR Std.
RiskAssessment.method Base example Not State Unknown
RiskAssessment.prediction.​qualitativeRisk Base required HEARTLAND Risk Tier Value Set 📦0.3.0 This IG

Constraints

Id Grade Path(s) Description Expression

Differential View

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. RiskAssessment 0..* RiskAssessment Potential outcomes for a subject with likelihood
... status S 1..1 code registered | preliminary | final | amended +
... method S 1..1 CodeableConcept Evaluation mechanism
.... text 1..1 string Plain text representation of the concept
Required Pattern: HEARTLAND Protocol v3.2 Risk Score
... subject S 1..1 Reference(HEARTLAND Patient | Patient) Who/what does assessment apply to?
... prediction S 1..1 BackboneElement Outcome predicted
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:scoreTotal S 0..1 integer Total HEARTLAND risk score (0-18 heuristic points, not a probability)
URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-score-total
.... probability[x] 0..0 Likelihood of specified outcome
.... qualitativeRisk S 1..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: HEARTLAND Risk Tier Value Set (required)

doco Documentation for this format

Terminology Bindings (Differential)

Path Status Usage ValueSet Version Source
RiskAssessment.prediction.​qualitativeRisk Base required HEARTLAND Risk Tier Value Set 📦0.3.0 This IG

Snapshot ViewView

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. RiskAssessment 0..* RiskAssessment Potential outcomes for a subject with likelihood
... id Σ 0..1 id Logical id of this artifact
... meta Σ 0..1 Meta Metadata about the resource
... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
... text 0..1 Narrative Text summary of the resource, for human interpretation
This profile does not constrain the narrative in regard to content, language, or traceability to data elements
... contained 0..* Resource Contained, inline Resources
... extension 0..* Extension Additional content defined by implementations
... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
... identifier Σ 0..* Identifier Unique identifier for the assessment
... basedOn 0..1 Reference(Resource) Request fulfilled by this assessment
... parent 0..1 Reference(Resource) Part of this occurrence
... status SΣ 1..1 code registered | preliminary | final | amended +
Binding: ObservationStatus (required): The status of the risk assessment; e.g. preliminary, final, amended, etc.
... method SΣ 1..1 CodeableConcept Evaluation mechanism
Binding Description: (example): The mechanism or algorithm used to make the assessment; e.g. TIMI, PRISM, Cardiff Type 2 diabetes, etc.
.... id 0..1 string Unique id for inter-element referencing
.... extension 0..* Extension Additional content defined by implementations
Slice: Unordered, Open by value:url
.... coding Σ 0..* Coding Code defined by a terminology system
.... text Σ 1..1 string Plain text representation of the concept
Required Pattern: HEARTLAND Protocol v3.2 Risk Score
... code Σ 0..1 CodeableConcept Type of assessment
... subject SΣ 1..1 Reference(HEARTLAND Patient | Patient) Who/what does assessment apply to?
... encounter Σ 0..1 Reference(Encounter) Where was assessment performed?
... occurrence[x] Σ 0..1 When was assessment made?
.... occurrenceDateTime dateTime
.... occurrencePeriod Period
... condition Σ 0..1 Reference(Condition) Condition assessed
... performer Σ 0..1 Reference(Practitioner | PractitionerRole | Device) Who did assessment?
... reasonCode 0..* CodeableConcept Why the assessment was necessary?
... reasonReference 0..* Reference(Condition | Observation | DiagnosticReport | DocumentReference) Why the assessment was necessary?
... basis S 1..* Reference(QuestionnaireResponse | Observation) Information used in assessment
... prediction SC 1..1 BackboneElement Outcome predicted
Constraints: ras-2
.... id 0..1 string Unique id for inter-element referencing
.... Slices for extension 0..* Extension Extension
Slice: Unordered, Open by value:url
..... extension:scoreTotal S 0..1 integer Total HEARTLAND risk score (0-18 heuristic points, not a probability)
URL: https://fhir.heartlandprotocol.org/StructureDefinition/heartland-risk-score-total
.... modifierExtension ?!Σ 0..* Extension Extensions that cannot be ignored even if unrecognized
.... outcome 0..1 CodeableConcept Possible outcome for the subject
Binding Description: (example): The condition or other outcome; e.g. death, remission, amputation, infection, etc.
.... qualitativeRisk S 1..1 CodeableConcept Likelihood of specified outcome as a qualitative value
Binding: HEARTLAND Risk Tier Value Set (required)
.... relativeRisk 0..1 decimal Relative likelihood
.... when[x] 0..1 Timeframe or age range
..... whenPeriod Period
..... whenRange Range
.... rationale 0..1 string Explanation of prediction
... mitigation 0..1 string How to reduce risk
... note 0..* Annotation Comments on the risk assessment

doco Documentation for this format

Terminology Bindings

Path Status Usage ValueSet Version Source
RiskAssessment.language Base preferred Common Languages 📍4.0.1 FHIR Std.
RiskAssessment.status Base required ObservationStatus 📍4.0.1 FHIR Std.
RiskAssessment.method Base example Not State Unknown
RiskAssessment.prediction.​outcome Base example Not State Unknown
RiskAssessment.prediction.​qualitativeRisk Base required HEARTLAND Risk Tier Value Set 📦0.3.0 This IG

Constraints

Id Grade Path(s) Description Expression

Summary

Mandatory: 5 elements
Must-Support: 7 elements
Prohibited: 1 element

Structures

This structure refers to these other structures:

Extensions

This structure refers to these extensions:

 

Other representations of profile: CSV, Excel, Schematron