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Seattle Heart Failure Model adequate in patients with advanced HF
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The Seattle Heart Failure Model offers adequate discrimination in patients with advanced HF, but absolute risk is often underestimated in blacks and in patients with devices, study results suggested.
Researchers examined 445 patients with advanced HF, with a total of 980 patient-year follow-up data. The primary endpoints were death, urgent cardiac transplantation or support using a left ventricular assist device. Study patients received optimal medical therapy. Of the 445 patients included, 92 (20.7%) died; the annual mortality rate was 9.4%.
The researchers reported that for the observed event vs. the event rate predicted by the Seattle HF Model, the model underestimated absolute risk at one year (11.0% vs. 9.2%), two years (21.0% vs. 16.6%) and three years (27.9% vs. 22.8%). There was also a modification effect of race on the coefficient of the Seattle HF Score (0.77 in whites vs. 1.15 in blacks; P=.010). The Seattle HF Model had better calibration when assessing mortality alone, but the interaction with race persisted (0.80 for whites vs. 1.10 for blacks; P=.037).
In an accompanying editorial, Stephen S. Gottlieb, MD, a cardiologist at the University of Maryland in Baltimore, noted that a well-designed HF score could yield important information.
“We will never know with certainty what will happen to an individual patient, but tested scores are better than clinical judgment in knowing the chances of death for that patient,” Gottlieb wrote. “Although future modifications will continue to improve predictive models, present imperfections should not prevent us from realizing that we can now identify black and white, acute and chronic patients who will have a better outcome with medical therapy than that expected with transplantation (or vice versa).”
J Am Coll Cardiol. 2009;53:334-342.