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The Cardiac Anesthesia Risk Evaluation (CARE) score is designed to assess the risk of mortality and morbidity for patients undergoing various types of surgery, based on their cardiac condition and urgency of surgery. Through this score, healthcare professionals can categorize patients into different risk levels, enabling them to make informed surgical and anesthetic decisions.

To determine the CARE score, the calculator requires two types of input:

- Patient Status is categorized into five distinct options, considering the stability and complexity of the cardiac disease and the type of surgery:
  - Stable cardiac disease, no additional medical issues, undergoing a non-complex surgery
  - Stable cardiac disease, with one or more controlled medical conditions, undergoing a non-complex surgery
  - Presence of any uncontrolled medical issue or undergoing a complex surgery
  - Presence of any uncontrolled medical issue and undergoing a complex surgery
  - Chronic or advanced cardiac condition, where surgery is viewed as a last-resort for life improvement or preservation

- Emergency Surgery dictates whether surgery should proceed immediately upon diagnosis:
  - Yes
  - No

Based on these inputs, the CARE score provides risk percentages for mortality and morbidity:

| Patient Status | Emergency | CARE Score | Mortality Risk | Morbidity Risk |
|----------------|-----------|------------|----------------|----------------|
| Stable, no other problems, non-complex surgery | No | CARE 1 | 0.5% | 5.4% |
| Stable, controlled problems, non-complex surgery | No | CARE 2 | 1.1% | 10.3% |
| Uncontrolled problems or complex surgery | No | CARE 3 | 2.2% | 19.0% |
| Uncontrolled problems or complex surgery | Yes | CARE 3E | 4.5% | 32.1% |
| Uncontrolled problems and complex surgery | No | CARE 4 | 8.8% | 48.8% |
| Uncontrolled problems and complex surgery | Yes | CARE 4E | 16.7% | 65.8% |
| Chronic/advanced disease, last hope surgery | No | CARE 5 | 29.3% | 79.6% |
| Chronic/advanced disease, last hope surgery | Yes | CARE 5E | 46.2% | 88.7% |

The CARE score is indicative of the risk, with values ranging from 1 to 5E. As the CARE score increases, so does the associated risk of in-hospital mortality and morbidity. Emergency surgeries, identified with an "E," generally exhibit higher risk percentages as compared to non-emergency procedures. Patients whose status falls under stable cardiac conditions with no further complications, receiving non-complex surgeries, are at the lowest risk (CARE 1), while those with chronic or advanced diseases undergoing surgery as a last hope stand at the highest risk level (CARE 5E).

The Cardiac Anesthesia Risk Evaluation (CARE) score is a clinical calculator used to assess the risk of perioperative cardiac complications in patients undergoing non-cardiac surgery. It is particularly useful in patients with known or suspected coronary artery disease. The CARE score takes into account factors such as age, type of surgery, history of myocardial infarction, angina, heart failure, stroke, diabetes, and renal insufficiency. The higher the score, the greater the risk of perioperative cardiac complications. This calculator is not applicable to patients undergoing cardiac surgery, as it is specifically designed for non-cardiac surgical procedures. The CARE score aids clinicians in decision-making regarding preoperative cardiac evaluation and management, and can guide discussions about surgical risk with patients.

Cardiac Anesthesia Risk Evaluation score (CARE score)

The calculator categorizes the severity of heart failure using the New York Heart Association (NYHA) functional classification system. It does this by analyzing a patient's reported physical abilities related to cardiac disease and matches them to one of the four NYHA classes.

Here's the breakdown of each class:

- Class I involves patients who have cardiac disease but do not experience any limitations in physical activity. Regular activities do not cause undue fatigue, palpitation, or shortness of breath.
  
- Class II fits patients who have a slight limitation in physical activity due to cardiac disease. They feel comfortable when at rest, but ordinary physical activities might lead to fatigue, palpitation, or breathlessness.
  
- Class III describes patients with a marked limitation in physical activity. These individuals are comfortable when resting, but even less than ordinary activities cause fatigue, palpitations, breathlessness, or chest pain.
  
- Class IV covers patients who cannot engage in any physical activity without experiencing discomfort. They exhibit symptoms of heart failure even when at rest, and any physical activity worsens these symptoms.

To determine the appropriate class for a patient, the calculator compares the user’s description of their physical ability with these four established patterns. Each condition is linked specifically to one of the NYHA classes, providing a clear pathway from symptom description to classification. For example, if a patient’s physical condition matches the criteria for Class I, then the result is "Class I." This comparison method efficiently identifies the level of heart failure severity based on self-reported abilities and symptoms.

The NYHA functional classification for heart failure, or New York Heart Association Functional Classification, is a scoring system used to quantify the severity of symptoms in patients with heart failure. This classification system is applicable to patients diagnosed with heart failure and is used to assess their functional capacity and limitations during physical activity. 

The NYHA classification is divided into four classes: Class I (no symptoms and no limitation in ordinary physical activity), Class II (mild symptoms and slight limitation during ordinary activity), Class III (marked limitation in activity due to symptoms, even during less-than-ordinary activity), and Class IV (severe limitations, experiences symptoms even while at rest).

The clinical utility of this calculator is to guide treatment decisions, assess prognosis, and evaluate the effectiveness of therapeutic interventions in patients with heart failure. It is also commonly used in clinical trials to stratify patients and measure outcomes. 

There are no specific exclusion criteria for its use, but it is subjective and relies on patient self-report, so it may not be as accurate in patients with cognitive impairment or communication difficulties.

NYHA functional classification for heart failure

The Revised Cardiac Risk Index (RCRI) calculator assesses perioperative cardiac risks by taking into account six specific risk factors associated with the patient. Each factor corresponds to a condition or characteristic, and if the patient exhibits that factor, it scores 1 point. The total score, ranging from 0 to 6, represents the overall cardiac risk.

The six risk factors analyzed are as follows:
1. High-risk surgery (intraperitoneal, intrathoracic, or suprainguinal vascular surgery)
2. History of ischemic heart disease (including myocardial infarction, positive exercise test, ECG with pathological Q waves, current ischemic chest pain, or use of nitrate)
3. History of congestive heart failure (with manifestations such as pulmonary edema, bilateral rales, S3 gallop, paroxysmal nocturnal dyspnea, or pulmonary vascular redistribution on chest X-ray)
4. History of cerebrovascular disease (transient ischemic attack or stroke)
5. Use of insulin for diabetes
6. Preoperative creatinine level above 2 mg/dL or 178 mcmol/L

A boolean input for each risk factor determines its presence, scoring 1 point if true and 0 if false. The sum of these points results in the total score.

Based on the computed score, the calculator provides an interpretation reflecting the patient's estimated risk of experiencing a major cardiac event (MI, cardiac arrest, or mortality) within 30 days post-surgery:

- Score of 0: Risk is 3.9%
- Score of 1: Risk is 6.0%
- Score of 2: Risk is 10.1%
- Score of 3 or more: Risk is 15.0%

The calculator simplifies the complex assessment of cardiac perioperative risks into a quantifiable measure, guiding healthcare providers in evaluating and mitigating potential cardiac complications in surgical patients. Here is the summary of how scores are interpreted in relation to risk percentages:

| Score | Risk Interpretation                                  |
|-------|------------------------------------------------------|
| 0     | Risk of 30-day MI, cardiac arrest, or mortality is 3.9% |
| 1     | Risk of 30-day MI, cardiac arrest, or mortality is 6.0% |
| 2     | Risk of 30-day MI, cardiac arrest, or mortality is 10.1% |
| 3 or more | Risk of 30-day MI, cardiac arrest, or mortality is 15.0% |

This structured approach helps balance the decision-making process by providing a clear estimate of cardiac risk based on specific, patient-related factors.

The Revised Cardiac Risk Index (RCRI) is a clinical calculator used to estimate the risk of cardiac complications during the perioperative period in patients undergoing non-cardiac surgery. It is particularly useful for stratifying patients into different risk categories based on six identified risk factors: high-risk surgery, history of ischemic heart disease, history of congestive heart failure, history of cerebrovascular disease, insulin therapy for diabetes, and preoperative serum creatinine >2.0 mg/dL. 

The RCRI is not applicable to patients undergoing cardiac surgery, as it was specifically designed for non-cardiac surgical procedures. It also may not be as accurate in populations not represented in the original study, such as those with less common comorbidities or undergoing less common surgical procedures.

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