Published online before print March 13, 2006, doi: 10.1161/CIRCULATIONAHA.105.584102
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:1424-1433.)
© 2006 American Heart Association, Inc.
Heart Failure |
The Seattle Heart Failure Model
Prediction of Survival in Heart Failure
From the University of Washington, Seattle (W.C.L., D.T.L., M.D.S.); Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass (D.M.); Merck Research Laboratories, Blue Bell, Pa (S.C.S.); Imperial College School of Medicine, London, UK (S.D.A., P.A.P.-W.); Pfizer Laboratories, Groton, Conn (A.B.C.); University of Minnesota, Minneapolis (I.A.); Italian Association of Hospital Cardiologists Research Center, Florence, Italy (A.M.); Amgen Inc, Thousand Oaks, Calif (P.B.); University of Michigan, Ann Arbor (B.P.); Baylor College of Medicine and Houston Veterans Affairs, Houston, Tex (D.L.M.); and University of Texas Southwestern Medical Center at Dallas (M.P.).
Correspondence to Wayne C. Levy, MD, Division of Cardiology, University of Washington, Box 356422, 1959 NE Pacific St, Seattle, WA 98177. E-mail levywc{at}u.washington.edu
Received August 30, 2005; revision received December 12, 2005; accepted January 13, 2006.
Background— Heart failure has an annual mortality rate ranging from 5% to 75%. The purpose of the study was to develop and validate a multivariate risk model to predict 1-, 2-, and 3-year survival in heart failure patients with the use of easily obtainable characteristics relating to clinical status, therapy (pharmacological as well as devices), and laboratory parameters.
Methods and Results— The Seattle Heart Failure Model was derived in a cohort of 1125 heart failure patients with the use of a multivariate Cox model. For medications and devices not available in the derivation database, hazard ratios were estimated from published literature. The model was prospectively validated in 5 additional cohorts totaling 9942 heart failure patients and 17 307 person-years of follow-up. The accuracy of the model was excellent, with predicted versus actual 1-year survival rates of 73.4% versus 74.3% in the derivation cohort and 90.5% versus 88.5%, 86.5% versus 86.5%, 83.8% versus 83.3%, 90.9% versus 91.0%, and 89.6% versus 86.7% in the 5 validation cohorts. For the lowest score, the 2-year survival was 92.8% compared with 88.7%, 77.8%, 58.1%, 29.5%, and 10.8% for scores of 0, 1, 2, 3, and 4, respectively. The overall receiver operating characteristic area under the curve was 0.729 (95% CI, 0.714 to 0.744). The model also allowed estimation of the benefit of adding medications or devices to an individual patient’s therapeutic regimen.
Conclusions— The Seattle Heart Failure Model provides an accurate estimate of 1-, 2-, and 3-year survival with the use of easily obtained clinical, pharmacological, device, and laboratory characteristics.
CLINICAL PERSPECTIVE
This article has been cited by other articles:
 |
|
 |
|
  B. Heidecker, E. K. Kasper, I. S. Wittstein, H. C. Champion, E. Breton, S. D. Russell, M. M. Kittleson, K. L. Baughman, and J. M. Hare Transcriptomic Biomarkers for Individual Risk Assessment in New-Onset Heart Failure Circulation, July 15, 2008; 118(3): 238 - 246. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Hauptman Does It Matter Why and How Patients With Heart Failure Die?: A Debate That Lives On Circ Heart Fail, July 1, 2008; 1(2): 89 - 90. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Sehnert, S. E. Daniels, M. Elashoff, J. A. Wingrove, C. R. Burrow, B. Horne, J. B. Muhlestein, M. Donahue, S. B. Liggett, J. L. Anderson, et al. Lack of Association Between Adrenergic Receptor Genotypes and Survival in Heart Failure Patients Treated With Carvedilol or Metoprolol J. Am. Coll. Cardiol., June 23, 2008; (2008) j.jacc.2008.05.022v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W.H. W. Tang The ongoing search for a stratified medicine approach in heart failure. J. Am. Coll. Cardiol., June 17, 2008; 51(24): 2310 - 2312. [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Allen, J. E. Yager, M. J. Funk, W. C. Levy, J. A. Tulsky, M. T. Bowers, G. C. Dodson, C. M. O'Connor, and G. M. Felker Discordance Between Patient-Predicted and Model-Predicted Life Expectancy Among Ambulatory Patients With Heart Failure JAMA, June 4, 2008; 299(21): 2533 - 2542. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Yancy Predicting Life Expectancy in Heart Failure JAMA, June 4, 2008; 299(21): 2566 - 2567. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kasama, T. Toyama, H. Sumino, M. Nakazawa, N. Matsumoto, Y. Sato, H. Kumakura, Y. Takayama, S. Ichikawa, T. Suzuki, et al. Prognostic Value of Serial Cardiac 123I-MIBG Imaging in Patients with Stabilized Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction J. Nucl. Med., June 1, 2008; 49(6): 907 - 914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): e1 - e62. [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. Mark Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2085 - 2105. [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): 2820 - 2840. [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons Circulation, May 27, 2008; 117(21): e350 - e408. [Full Text] [PDF]
|
|
|
|
|
|
I. S. Anand, T. S. Rector, M. Kuskowski, S. Thomas, N.J. Holwerda, and J. N. Cohn Effect of Baseline and Changes in Systolic Blood Pressure Over Time on the Effectiveness of Valsartan in the Valsartan Heart Failure Trial Circ Heart Fail, May 1, 2008; 1(1): 34 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Thune, J. Signorovitch, L. Kober, E. J. Velazquez, J. J.V. McMurray, R. M. Califf, A. P. Maggioni, J. L. Rouleau, J. Howlett, S. Zelenkofske, et al. Response to The J-Point Revisited Hypertension, May 1, 2008; 51(5): e35 - e35. [Full Text] [PDF]
|
|
|
|
|
|
W. C. Levy Anemia in heart failure: marker or mediator of adverse prognosis? J. Am. Coll. Cardiol., February 5, 2008; 51(5): 577 - 578. [Full Text] [PDF]
|
|
|
|
 |
|
 N. E. Goldstein and D. Fischberg Update in Palliative Medicine Ann Intern Med, January 15, 2008; 148(2): 135 - 140. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Thune, J. Signorovitch, L. Kober, E. J. Velazquez, J. J.V. McMurray, R. M. Califf, A. P. Maggioni, J. L. Rouleau, J. Howlett, S. Zelenkofske, et al. Effect of Antecedent Hypertension and Follow-Up Blood Pressure on Outcomes After High-Risk Myocardial Infarction Hypertension, January 1, 2008; 51(1): 48 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. S. Braithwaite, J. Concato, C. C. Chang, M. S. Roberts, and A. C. Justice A Framework for Tailoring Clinical Guidelines to Comorbidity at the Point of Care Arch Intern Med, November 26, 2007; 167(21): 2361 - 2365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Sandek, J. Bauditz, A. Swidsinski, S. Buhner, J. Weber-Eibel, S. von Haehling, W. Schroedl, T. Karhausen, W. Doehner, M. Rauchhaus, et al. Altered Intestinal Function in Patients With Chronic Heart Failure J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1561 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Hauptman, S. J. Goodlin, M. Lopatin, M. R. Costanzo, G. C. Fonarow, C. W. Yancy, and for the ADHERE Scientific Advisory Committee and A Characteristics of Patients Hospitalized With Acute Decompensated Heart Failure Who Are Referred for Hospice Care Arch Intern Med, October 8, 2007; 167(18): 1990 - 1997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Wang Significance of Circulating Troponins in Heart Failure: If These Walls Could Talk Circulation, September 11, 2007; 116(11): 1217 - 1220. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Mosterd and A. W Hoes Clinical epidemiology of heart failure Heart, September 1, 2007; 93(9): 1137 - 1146. [Full Text] [PDF]
|
|
|
|
|
|
L. W. Stevenson and G. Couper On the Fledgling Field of Mechanical Circulatory Support J. Am. Coll. Cardiol., August 21, 2007; 50(8): 748 - 751. [Full Text] [PDF]
|
|
|
|
|
|
K. Lietz, J. W. Long, A. G. Kfoury, M. S. Slaughter, M. A. Silver, C. A. Milano, J. G. Rogers, Y. Naka, D. Mancini, and L. W. Miller Outcomes of Left Ventricular Assist Device Implantation as Destination Therapy in the Post-REMATCH Era: Implications for Patient Selection Circulation, July 31, 2007; 116(5): 497 - 505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Goldberg and M. Jessup A Time to be Born and a Time to Die Circulation, July 24, 2007; 116(4): 360 - 362. [Full Text] [PDF]
|
|
|
|
|
|
D. Mozaffarian, S. D. Anker, I. Anand, D. T. Linker, M. D. Sullivan, J. G.F. Cleland, P. E. Carson, A. P. Maggioni, D. L. Mann, B. Pitt, et al. Prediction of Mode of Death in Heart Failure: The Seattle Heart Failure Model Circulation, July 24, 2007; 116(4): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Felker, L. A. Allen, S. J. Pocock, L. K. Shaw, J. J.V. McMurray, M. A. Pfeffer, K. Swedberg, D. Wang, S. Yusuf, E. L. Michelson, et al. Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank J. Am. Coll. Cardiol., July 3, 2007; 50(1): 40 - 47. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Le Jemtel and S. Jelic Seek and Treat Obstructive Sleep Apnea in Heart Failure J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1632 - 1633. [Full Text] [PDF]
|
|
|
|
|
|
J. Butler and A. Leon The Elusive Scourge of Sudden Cardiac Death: Is Rational Decision Making Possible? Should There Be Standards of Risks and Predictions in Medicine? J. Am. Coll. Cardiol., April 3, 2007; 49(13): 1434 - 1435. [Full Text] [PDF]
|
|
|
|
|
|
I. Goldenberg, A. J. Moss, S. McNitt, W. Zareba, W. J. Hall, M. L. Andrews, and for the MADIT-II Investigators Inverse Relationship of Blood Pressure Levels to Sudden Cardiac Mortality and Benefit of the Implantable Cardioverter-Defibrillator in Patients With Ischemic Left Ventricular Dysfunction J. Am. Coll. Cardiol., April 3, 2007; 49(13): 1427 - 1433. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. C. Huynh, A. Rovner, and M. W. Rich Long-term Survival in Elderly Patients Hospitalized for Heart Failure: 14-Year Follow-up From a Prospective Randomized Trial. Arch Intern Med, September 25, 2006; 166(17): 1892 - 1898. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Tool for Predicting Survival in Heart Failure Journal Watch Cardiology, May 4, 2006; 2006(504): 4 - 4. [Full Text]
|
|