Published online before print July 9, 2007, doi: 10.1161/CIRCULATIONAHA.106.687103
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(Circulation. 2007;116:392-398.)
© 2007 American Heart Association, Inc.
Heart Failure |
Prediction of Mode of Death in Heart Failure
The Seattle Heart Failure Model
From the Harvard Medical School and Harvard School of Public Health (D.M.), Boston, Mass; Charité, Campus Virchow-Klinikum, (S.A.) Berlin, Germany; University of Minnesota (I.A.), Minneapolis; University of Washington (D.T.L., M.D.S., W.C.L.), Seattle; Castle Hill Hospital (J.G.F.C.), Kingston-upon-Hull, UK; Veterans Administration Medical Center (P.E.C.), Washington, DC; Italian Association of Hospital Cardiologists Research Center (A.P.M.), Florence, Italy; Baylor College of Medicine and the Houston Veterans Administration (D.L.M.), Houston, Tex; University of Michigan (B.P.), Ann Arbor; and the Imperial College School of Medicine (P.A.P.), London, UK.
Correspondence to Dr Dariush Mozaffarian, 665 Huntington Ave, Bldg 2–319, Boston, MA 02115. E-mail dmozaffa{at}hsph.harvard.edu
Received January 12, 2007; accepted April 30, 2007.
Background— Prognosis and mode of death in heart failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive failure of cardiac function (pump failure). Prediction of mode of death may facilitate decisions about specific medications or devices.
Methods and Results— We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in heart failure, to assess the mode of death in 10 538 ambulatory patients with New York Heart Association class II to IV heart failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16 735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.68). Stratification of risk of pump-failure death was even more pronounced, with a 4-fold higher risk with a score of 1, a 15-fold higher risk with a score of 2, a 38-fold higher risk with a score of 3, and an 88-fold higher risk with a score of 4 (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.85). The proportion of deaths caused by sudden death versus pump-failure death decreased from a ratio of 7:1 with a SHFM score of 0 to a ratio of 1:2 with a SHFM score of 4 (P trend <0.001).
Conclusions— The SHFM score provides information about the likely mode of death among ambulatory heart failure patients. Investigation is warranted to determine whether such information might predict responses to or cost-effectiveness of specific medications or devices in heart failure patients.
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