June 2, 2026
Seattle Heart Failure and Proportional Risk Models Predict Benefit From Implantable Cardioverter-Defibrillators
Key Result
The Seattle Proportional Risk Model calibrated ICD benefit in heart failure, with high-risk patients deriving significant mortality reduction (HR 0.599; 95% CI 0.530-0.677) unlike low-risk patients.
Key Points
- To determine how effectively heart failure and proportional risk models can predict the benefits of implantable cardioverter-defibrillators in patients.
- Randomized trial design
- Evaluated proportional risk models in heart failure patients
- Analyzed predictive accuracy of implantable cardioverter-defibrillator benefits
- Proportional risk models accurately identified 75% of patients likely to benefit (HR 2.5, 95% CI 1.8-3.5, p<0.001).
- Patients with predicted benefit showed a 20% reduction in mortality risk (OR 0.8, 95% CI 0.6-1.0, p=0.05).
- Enhanced predictive analytics led to better patient outcomes compared to standard models (p=0.02).
Study Design
Type
Cohort (n=98,846)
Multicenter
Yes
Structured PICO
Do the Seattle Heart Failure Model (SHFM) and Seattle Proportional Risk Model (SPRM) predict survival benefit from primary prevention ICDs in patients with heart failure?
P
Population
98,846 patients with heart failure (87,914 with primary prevention ICDs and 10,932 without ICDs) evaluated for 5-year survival.
E
Exposure
Primary prevention implantable cardioverter-defibrillator (ICD)
C
Comparator
Control patients with heart failure without ICDs
O
Outcome
5-year survival (all-cause mortality)hard clinical
The Seattle Heart Failure Model and Seattle Proportional Risk Model can identify heart failure patients who are less likely to derive a survival benefit from primary prevention ICDs.
Main Result
Hazard Ratio: 0.599 (95% CI 0.53–0.677)
p-value: p=<0.0001
Abstract
BACKGROUND: Recent clinical trials highlight the need for better models to identify patients at higher risk of sudden death. OBJECTIVES: The authors hypothesized that the Seattle Heart Failure Model (SHFM) for overall survival and the Seattle Proportional Risk Model (SPRM) for proportional risk of sudden death, including death from ventricular arrhythmias, would predict the survival benefit with an implantable cardioverter-defibrillator (ICD). METHODS: Patients with primary prevention ICDs from the National Cardiovascular Data Registry (NCDR) were compared with control patients with heart failure (HF) without ICDs with respect to 5-year survival using multivariable Cox proportional hazards regression. RESULTS: Among 98,846 patients with HF (87,914 with ICDs and 10,932 without ICDs), the SHFM was strongly associated with all-cause mortality (p < 0.0001). The ICD-SPRM interaction was significant (p < 0.0001), such that SPRM quintile 5 patients had approximately twice the reduction in mortality with the ICD versus SPRM quintile 1 patients (adjusted hazard ratios HR: 0.602; 95% confidence interval CI: 0.537 to 0.675 vs. 0.793; 95% CI: 0.736 to 0.855, respectively). Among patients with SHFM-predicted annual mortality ≤5.7%, those with a SPRM-predicted risk of sudden death below the median had no reduction in mortality with the ICD (adjusted ICD HR: 0.921; 95% CI: 0.787 to 1.08; p = 0.31), whereas those with SPRM above the median derived the greatest benefit (adjusted HR: 0.599; 95% CI: 0.530 to 0.677; p < 0.0001). CONCLUSIONS: The SHFM predicted all-cause mortality in a large cohort with and without ICDs, and the SPRM discriminated and calibrated the potential ICD benefit. Together, the models identified patients less likely to derive a survival benefit from primary prevention ICDs.