This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by De Marco, T. Articles by Goldman, L. Search for Related Content PubMed PubMed Citation Articles by De Marco, T. Articles by Goldman, L.

(Circulation. 1997;95:2597-2599.)
© 1997 American Heart Association, Inc.

Articles

Predicting Outcomes in Severe Heart Failure

Teresa De Marco, MD; Lee Goldman, MD

the University of California, San Francisco, Department of Medicine.

Key Words: Editorials • transplantation • prognosis • heart failure

	Introduction

 
The crisis in cardiac transplantation will soon be upon us. With current candidate-selection practices, heart-distribution priorities, and inadequate numbers of donor hearts, the cardiac transplant system is projected to reach a dynamic equilibrium in 1998.¹ At that time, 100% of available hearts will go to high-priority inpatients who cannot be weaned from intravenous inotropic agents or mechanical assist devices in the intensive care unit setting. Because high-priority candidates have a higher posttransplant mortality than low-priority outpatient candidates, the number of patients who die due to transplantation or are left destitute on the waiting list will double.^{1 2 3} Current trends confirm this impending crisis, as the percent of candidates on the waiting list for >1 year has increased from 12.5% in 1988 to 45.4% in 1994.⁴ A proposed solution to the crisis would be to list only candidates younger than 56 years of age whose 1-year survival without clinical deterioration to high-priority status is projected to be 20%.¹ This practice would result in the distribution of half of donor hearts to high-priority candidates and half to low-priority candidates and would reduce the number of postoperative deaths and destitute candidates, thus maximizing donor-heart utilization. The key to this potential solution is better prediction of outcomes.

	Prediction: How Useful for Decision Making?

 
Is it supposed to rain today? Should I take an umbrella? These simple questions, which many of us face every day, also describe symbolically the issues faced by clinicians who try to use predictions to improve clinical decisions. In weather forecasting, sophisticated mathematical models produce better predictions than . . . [Full Text of this Article]

This article has been cited by other articles:

				M. Demir, M. Kanadasi, O. Akpinar, Y. Donmez, M. Avkarogullari, C. Alhan, T. Inal, M. San, A. Usal, and M. Demirtas Cardiac Troponin T as a Prognostic Marker in Patients With Heart Failure : A 3-Year Outcome Study Angiology, November 1, 2007; 58(5): 603 - 609. [Abstract] [PDF]

				E. Loh, T. R. Rebbeck, P. D. Mahoney, D. DeNofrio, J. L. Swain, and E. W. Holmes Common Variant in AMPD1 Gene Predicts Improved Clinical Outcome in Patients With Heart Failure Circulation, March 23, 1999; 99(11): 1422 - 1425. [Abstract] [Full Text] [PDF]