HEARTLAND Protocol FHIR Implementation Guide - Compilação de desenvolvimento local (v0.1.0) construída pelas ferramentas de compilação FHIR (HL7® FHIR® Standard). Veja o Diretório de versões publicadas

Risk Assessment

Risk Assessment Workflow

The HEARTLAND risk score stratifies HF patients at discharge into three tiers using ten binary inputs.

Inputs (HEARTLAND v3.2 Risk Score)

linkId	Item text	Points
age-75	Age >=75 years	2
hf-hosp-6mo	Prior heart failure hospitalization within 6 months	3
egfr-low	eGFR <45 mL/min/1.73m^2	2
natriuretic-high	BNP >=500 pg/mL or NT-proBNP >=1500 pg/mL	2
sbp-low	Systolic BP <100 mmHg at admission	2
diabetes	Diabetes mellitus	1
lvef-low	LVEF <30%	2
ckm-stage	Cardiovascular-kidney-metabolic Stage 3 or 4	2
distance-far	Distance to cardiology care >50 miles	1
social-support	Lives alone or limited social support	1
Total possible		18

Tier Cutoffs

Total score	Tier	Recommended bundle
0-4	Low	Standard monitoring
5-8	Moderate	Enhanced monitoring bundle
>=9	High	Intensive monitoring bundle

FHIR Workflow

1. Capture inputs as a HeartlandQuestionnaireResponse instance referencing the HeartlandRiskInputQuestionnaire canonical URL.
2. Compute total score by summing the point values of items answered true.
3. Map score to tier using the cutoff table above.
4. Create a HeartlandRiskAssessment with:

   • prediction.qualitativeRisk bound to the resulting HeartlandRiskTier code (low

     moderate

     high).

   • prediction.probabilityDecimal set to the integer total (0-18).
   • basis referencing the HeartlandQuestionnaireResponse.
   • method.text exactly "HEARTLAND Protocol v3.2 Risk Score".

Patient Extensions

Two HEARTLAND-specific Patient extensions surface the score's social determinants:

• heartland-distance-to-cardiology — Quantity in miles ([mi_us] UCUM)
• heartland-social-support-score — boolean (true = limited social support)

Use the HeartlandPatient profile to bundle both.

Worked Example

PatientExampleRural is a 78-year-old female in rural Montana, 87 miles from the nearest cardiologist, living alone.

QuestionnaireResponseExampleRiskInputs records six of ten items as true:

• age-75 (+2)
• hf-hosp-6mo (+3)
• sbp-low (+2)
• ckm-stage (+2)
• distance-far (+1)
• social-support (+1)

Total = 11 points -> High Risk tier -> Intensive monitoring bundle.

RiskAssessmentExampleHigh records this result and references the questionnaire response as basis.

Evidence Note

The HEARTLAND Risk Score is labeled pragmatic per the HeartlandEvidenceLevel code system: developed for clinical utility without formal external statistical validation. It is intended as a triage tool to assign monitoring intensity, not as a survival predictor like MAGGIC. Programs using HEARTLAND should consider concurrent validation in their local population.