Cardiology Respiratory

REVEAL 2.0 Risk Score for Pulmonary Arterial Hypertension

REVEAL 2.0 (Benza 2019) predicts 1-year mortality in WHO group 1 pulmonary arterial hypertension from 13 variables (score 0–23). A test not done scores 0.

Used in: Hypertension

PAH subgroup (WHO group 1)*

Male and age > 60 years*

eGFR < 60 mL/min/1.73 m² (or renal insufficiency if eGFR unavailable)*

NYHA / WHO functional class*

All-cause hospitalisation within the previous 6 months*

Systolic BP < 110 mmHg at rest*

Heart rate > 96 bpm at rest*

6-minute walk distance*

BNP or NT-proBNP*

Pericardial effusion on echocardiogram*

DLCO (% predicted)*

Mean right atrial pressure > 20 mmHg (right heart catheter within 1 year)*

Pulmonary vascular resistance (right heart catheter within 1 year)*

Score interpretation

Low Risk 0–6

REVEAL 2.0 ≤ 6: low risk of death within 1 year (Benza 2019).

→ Continue and optimise PAH therapy; reassess every 3–6 months. Low risk is the treatment goal.

Intermediate Risk 7–8

REVEAL 2.0 7–8: intermediate risk of death within 1 year.

→ Escalate therapy per ESC/ERS 2022; review at a specialist PAH centre.

High Risk 9–23

REVEAL 2.0 ≥ 9: high risk of death within 1 year.

→ Maximal therapy including parenteral prostacyclin; refer for lung transplant evaluation.

Interpretation bands for the REVEAL 2.0. Apply clinical judgement and local guidance.

References

Benza RL et al. Predicting survival in patients with pulmonary arterial hypertension: the REVEAL risk score calculator 2.0 and comparison with ESC/ERS-based risk assessment strategies. Chest. 2019;156(2):323–337.
Benza RL et al. Predicting Survival in Pulmonary Arterial Hypertension: Insights from the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL). Circulation. 2010;122(2):164-172.

Curated clinical cross-links plus same-class fallbacks.

Calculators

WHO Functional Class and Four-Strata Risk in PAH (ESC/ERS 2022) · Pulmonary Hypertension

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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