Circulation. 2006;113:1424-1433
Published online before print March 13, 2006, doi: 10.1161/CIRCULATIONAHA.105.584102
Published online before print March 13, 2006, doi: 10.1161/CIRCULATIONAHA.105.584102
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(Circulation. 2006;113:1424-1433.)
© 2006 American Heart Association, Inc.
Heart Failure |
The Seattle Heart Failure Model
Prediction of Survival in Heart Failure
From the University of Washington, Seattle (W.C.L., D.T.L., M.D.S.); Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass (D.M.); Merck Research Laboratories, Blue Bell, Pa (S.C.S.); Imperial College School of Medicine, London, UK (S.D.A., P.A.P.-W.); Pfizer Laboratories, Groton, Conn (A.B.C.); University of Minnesota, Minneapolis (I.A.); Italian Association of Hospital Cardiologists Research Center, Florence, Italy (A.M.); Amgen Inc, Thousand Oaks, Calif (P.B.); University of Michigan, Ann Arbor (B.P.); Baylor College of Medicine and Houston Veterans Affairs, Houston, Tex (D.L.M.); and University of Texas Southwestern Medical Center at Dallas (M.P.).
Correspondence to Wayne C. Levy, MD, Division of Cardiology, University of Washington, Box 356422, 1959 NE Pacific St, Seattle, WA 98177. E-mail levywc{at}u.washington.edu
Received August 30, 2005; revision received December 12, 2005; accepted January 13, 2006.
Background— Heart failure has an annual mortality rate ranging from 5% to 75%. The purpose of the study was to develop and validate a multivariate risk model to predict 1-, 2-, and 3-year survival in heart failure patients with the use of easily obtainable characteristics relating to clinical status, therapy (pharmacological as well as devices), and laboratory parameters.
Methods and Results— The Seattle Heart Failure Model was derived in a cohort of 1125 heart failure patients with the use of a multivariate Cox model. For medications and devices not available in the derivation database, hazard ratios were estimated from published literature. The model was prospectively validated in 5 additional cohorts totaling 9942 heart failure patients and 17 307 person-years of follow-up. The accuracy of the model was excellent, with predicted versus actual 1-year survival rates of 73.4% versus 74.3% in the derivation cohort and 90.5% versus 88.5%, 86.5% versus 86.5%, 83.8% versus 83.3%, 90.9% versus 91.0%, and 89.6% versus 86.7% in the 5 validation cohorts. For the lowest score, the 2-year survival was 92.8% compared with 88.7%, 77.8%, 58.1%, 29.5%, and 10.8% for scores of 0, 1, 2, 3, and 4, respectively. The overall receiver operating characteristic area under the curve was 0.729 (95% CI, 0.714 to 0.744). The model also allowed estimation of the benefit of adding medications or devices to an individual patient’s therapeutic regimen.
Conclusions— The Seattle Heart Failure Model provides an accurate estimate of 1-, 2-, and 3-year survival with the use of easily obtained clinical, pharmacological, device, and laboratory characteristics.
CLINICAL PERSPECTIVE
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P. J. Hauptman, S. J. Goodlin, M. Lopatin, M. R. Costanzo, G. C. Fonarow, C. W. Yancy, and for the ADHERE Scientific Advisory Committee and A Characteristics of Patients Hospitalized With Acute Decompensated Heart Failure Who Are Referred for Hospice Care Arch Intern Med, October 8, 2007; 167(18): 1990 - 1997. [Abstract] [Full Text] [PDF]
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M. Metra, P. Ponikowski, K. Dickstein, J. J.V. McMurray, A. Gavazzi, C.-H. Bergh, A. G. Fraser, T. Jaarsma, A. Pitsis, P. Mohacsi, et al. Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology Eur J Heart Fail, June 1, 2007; 9(6-7): 684 - 694. [Abstract] [Full Text] [PDF]
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T. H. Le Jemtel and S. Jelic Seek and Treat Obstructive Sleep Apnea in Heart Failure J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1632 - 1633. [Full Text] [PDF]
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J. Butler and A. Leon The Elusive Scourge of Sudden Cardiac Death: Is Rational Decision Making Possible? Should There Be Standards of Risks and Predictions in Medicine? J. Am. Coll. Cardiol., April 3, 2007; 49(13): 1434 - 1435. [Full Text] [PDF]
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