The Seattle Heart Failure Model offered modest discrimination for mortality, VAD, or urgent transplantation (c-index 0.628-0.683) and underestimated risk in patients listed for nonurgent transplant.
Cohort (n=215)
No
Does the Seattle Heart Failure Model accurately predict the composite of mortality, VAD, or urgent transplantation in ambulatory patients with advanced heart failure?
The Seattle Heart Failure Model provides only modest discrimination and underestimates risk in ambulatory patients with advanced heart failure evaluated for transplantation, suggesting it should be used with caution in this specific population.
Background— We sought to assess the predictive value of the Seattle Heart Failure Model (SHFM) when applied to ambulatory patients with advanced heart failure (HF) presented to an advanced HF therapeutics committee at a tertiary care US institution. Methods and Results— We evaluated model discrimination and calibration in 215 consecutive ambulatory patients who were presented to the Cleveland Clinic advanced HF therapeutics committee between 2004 to 2007 for evaluation for advanced options including transplantation and ventricular assist device (VAD). Analyses were stratified by committee decision (not listed versus listed United Network of Organ Sharing UNOS Status 2). Eighty-five percent had 1 or no missing SHFM variables. The primary outcome was a composite of all-cause mortality, VAD, or urgent (UNOS Status 1) transplantation. During a median follow-up of 24 months, 68 died, 18 received VAD support, and 81 underwent heart transplantation. Discrimination was modest both for those not listed (c-index, 0.683 at 1 year and 0.648 at 2 years), and for those listed UNOS status 2 (c-index, 0.629 at 1 year and 0.628 at 2 years). Calibration was acceptable among those patients not listed for heart transplantation but with substantial underestimation of risk (ie, overestimation of survival free of VAD or urgent transplantation) among UNOS status 2 patients. Conclusions— In ambulatory patients presented to an advanced HF therapeutics committee for evaluation for heart transplantation, the SHFM offers modest discrimination of risk for the primary composite outcome of mortality, VAD, or urgent transplantation, with underestimation of risk in those patients listed for nonurgent transplantation. Interpretation of risk prediction by the SHFM in this patient population must be done with caution.
Gorodeski et al. (Fri,) conducted a cohort in advanced heart failure (n=215). Seattle Heart Failure Model (SHFM) was evaluated on Composite of all-cause mortality, VAD, or urgent (UNOS Status 1) transplantation. The Seattle Heart Failure Model offered modest discrimination for mortality, VAD, or urgent transplantation (c-index 0.628-0.683) and underestimated risk in patients listed for nonurgent transplant.