Which clinical sign is a poor prognostic indicator in the Goldman Index?

Uncompensated congestive heart failure (CHF) is considered a poor prognostic indicator in the Goldman Index because it reflects significant cardiovascular instability and a higher risk of perioperative complications. When CHF is uncompensated, it indicates that the patient's heart is unable to maintain adequate blood flow to meet the body's needs, particularly during the stress of surgery. This situation increases the likelihood of adverse outcomes, including postoperative morbidity, longer hospital stays, and even mortality.

In contrast, bradycardia, controlled arrhythmias, and stable angina typically suggest better overall cardiovascular status. While each of these can have implications for surgical risk, they do not inherently denote the same level of compromised physiological reserve that uncompensated CHF does. For instance, bradycardia may occur in well-managed patients and could be a sign of good conditioning. Controlled arrhythmias imply that the heart's rhythm is regulated effectively, while stable angina suggests that the patient is experiencing predictable chest pain but is generally stable.

Thus, the presence of uncompensated CHF in a patient's clinical picture is a significant red flag regarding surgical risk and outcomes, which is why it is classified as a poor prognostic indicator within the Goldman Index.