Surgical Risk Models
OpenBeat® integrates three internationally validated cardio thoracic surgical risk scoring models — EuroSCORE II, ACEF, and CARE Score — calculated automatically from the patient's clinical data at the point of case entry.
Automatic Calculation
Risk scores are computed in real time as clinical data is entered — no manual calculation required.
Validated Models
All models are internationally peer-reviewed and aligned with STS, EACTS, and anaesthesia registry standards.
Outcomes Benchmarking
Predicted risk scores are stored against actual outcomes, enabling ongoing departmental performance analysis.
EuroSCORE II
European System for Cardiac Operative Risk Evaluation II
EuroSCORE II is the current gold-standard logistic risk model for cardiac surgery in Europe and widely adopted internationally. It predicts in-hospital mortality for adult cardiac surgery using 18 patient and procedural variables.
Input Variables
Patient Factors
- Age
- Gender
- Serum creatinine
- Extracardiac arteriopathy
- Poor mobility
- Previous cardiac surgery
- Chronic lung disease
- Active endocarditis
- Critical pre-operative state
- Diabetes on insulin
Cardiac Factors
- NYHA functional class
- CCS angina class 4
- LV function (EF)
- Recent MI (≤90 days)
- Pulmonary arterial hypertension
Operative Factors
- Urgency of surgery
- Weight of the intervention
- Surgery on thoracic aorta
Model Output
Predicted in-hospital mortality (%) — logistic regression model
Validation & Evidence Base
Validated across >22,000 patients in 43 countries (2010 EuroSCORE II study). Regularly benchmarked against STS outcomes data.
Clinical Use Case in OpenBeat®
Pre-operative patient counselling, consent documentation, departmental mortality benchmarking, and STS/EACTS registry submission.
Clinical note: EuroSCORE II tends to underestimate risk in high-risk subgroups. Supplement with clinical judgment for complex re-operations and combined procedures.
ACEF Score
Age, Creatinine, and Ejection Fraction Score
The ACEF score is a simplified, three-variable risk model designed for rapid bedside risk stratification in cardiac surgery. Its simplicity makes it particularly useful in emergency settings and for quick triage assessments.
Input Variables
Three Core Variables
- Age (years)
- Serum creatinine (mg/dL)
- Ejection fraction (%)
Model Output
ACEF Score = Age ÷ Ejection Fraction + 1 (if creatinine > 2.0 mg/dL)
Validation & Evidence Base
Validated in multiple European cohorts. Demonstrates comparable discriminatory power to EuroSCORE for isolated CABG in several studies (AUC 0.73–0.79).
Clinical Use Case in OpenBeat®
Rapid pre-operative triage, emergency case risk flagging, and as a complementary check alongside EuroSCORE II in routine elective cases.
Clinical note: ACEF is intentionally simplified. It does not account for procedural complexity, urgency, or comorbidity burden beyond renal function. Always use alongside a full model for complex cases.
CARE Score
Cardiac Anaesthesia Risk Evaluation Score
The CARE Score (Cardiac Anaesthesia Risk Evaluation) is a validated, anaesthesia-specific risk stratification tool developed for cardiac surgery patients. It is widely used in Indian and Asian cardiac surgery centres and is particularly relevant for populations with a higher prevalence of rheumatic heart disease and younger patient demographics.
Input Variables
Core Variables
- Controlled systemic disease (e.g. hypertension, diabetes)
- Uncontrolled systemic disease
- Presence of cardiovascular dysfunction
- Urgency of surgery (elective / urgent / emergency)
- Complexity of cardiac surgery (simple / complex / complex + non-cardiac)
Model Output
Risk category: Low (1–2), Moderate (3), High (4), Very High (5) — with associated predicted mortality ranges per category
Validation & Evidence Base
Originally described by Dupuis et al. and subsequently validated in Indian cardiac surgery populations. Demonstrates good discriminatory ability (AUC 0.74–0.82) across diverse cardiac surgery cohorts in South and Southeast Asia.
Clinical Use Case in OpenBeat®
Pre-anaesthetic risk assessment, anaesthesia team planning, patient and family counselling, and as a complementary risk tool alongside EuroSCORE II in Indian and Asian cardiac surgery centres.
Clinical note: CARE Score is an anaesthesia-focused tool and does not replace a full surgical risk model. It is best used in conjunction with EuroSCORE II or ACEF for a complete pre-operative risk picture. Particularly well-suited for centres managing a high proportion of rheumatic valve disease and younger patients.
Model Comparison
OpenBeat® calculates all three models simultaneously — giving your team a complete risk picture at a glance.
| Attribute | EuroSCORE II | ACEF Score | CARE Score |
|---|---|---|---|
| Variables | 18 | 3 | 5 |
| Procedure scope | All adult cardiac surgery | All adult cardiac surgery | All cardiac surgery (anaesthesia focus) |
| Output | In-hospital mortality % | Numeric score (risk index) | Risk category (low / moderate / high / very high) |
| Registry alignment | EACTS / EuroSCORE | General / supplementary | Anaesthesia / Indian cardiac centres |
| Best for | European benchmarking, consent | Rapid triage, emergency cases | Anaesthesia risk stratification, Indian centres |
| Complexity | Moderate | Low | Low–Moderate |
Clinical Decision Support — Not a Substitute for Clinical Judgment
Risk scores generated by OpenBeat® are decision-support tools derived from validated statistical models. They are intended to inform — not replace — the clinical judgment of qualified cardiac surgeons and multidisciplinary heart teams. Individual patient risk may differ from model predictions. All treatment decisions remain the responsibility of the treating clinician.
See OpenBeat® in Action
Request a free trial to explore how OpenBeat® integrates risk scoring, case capture, and outcomes reporting in a single platform built for cardiac surgery teams.