Published Online
on July 9, 2007

A more recent version of this article appeared on July 24, 2007

This Article Full Text (PDF) CME: Take the course for this article: Circulation: July 24, 2007, Volume 116, Number 4 All Versions of this Article: 116/4/392    most recent CIRCULATIONAHA.106.687103v1 Alert me when this article is cited Alert me if a correction is posted 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 Mozaffarian, D. Articles by Levy, W. C. Search for Related Content PubMed PubMed Citation Articles by Mozaffarian, D. Articles by Levy, W. C. Pubmed/NCBI databases Medline Plus Health Information Cardiac Arrest Heart Failure Related Collections Congestive

Submitted on January 12, 2007
Accepted on April 30, 2007

Prediction of Mode of Death in Heart Failure. The Seattle Heart Failure Model

Dariush Mozaffarian MD, DrPH^*, Stefan D. Anker MD, Inder Anand MD, David T. Linker MD, Mark D. Sullivan MD, PhD, John G.F. Cleland MD, Peter E. Carson MD, Aldo P. Maggioni MD, Douglas L. Mann MD, Bertram Pitt MD, Philip A. Poole-Wilson MD, and Wayne C. Levy MD

From the Harvard Medical School and Harvard School of Public Health (D.M.), Boston, Mass; Charité, Campus Virchow-Klinikum, (S.A.) Berlin, Germany; University of Minnesota (I.A.), Minneapolis; University of Washington (D.T.L., M.D.S., W.C.L.), Seattle; Castle Hill Hospital (J.G.F.C.), Kingston-upon-Hull, United Kingdom; Veterans Administration Medical Center (P.E.C.), Washington, DC; Italian Association of Hospital Cardiologists Research Center (A.P.M.), Florence, Italy; Baylor College of Medicine and the Houston Veterans Administration (D.L.M.), Houston, Tex; University of Michigan (B.P.), Ann Arbor; and the Imperial College School of Medicine (P.A.P.), London, United Kingdom.

^* To whom correspondence should be addressed. E-mail: dmozaffa{at}hsph.harvard.edu.

Background--Prognosis and mode of death in heart failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive failure of cardiac function (pump failure). Prediction of mode of death may facilitate decisions about specific medications or devices.

Methods and Results--We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in heart failure, to assess the mode of death in 10 538 ambulatory patients with New York Heart Association class II to IV heart failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16 735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.68). Stratification of risk of pump-failure death was even more pronounced, with a 4-fold higher risk with a score of 1, a 15-fold higher risk with a score of 2, a 38-fold higher risk with a score of 3, and an 88-fold higher risk with a score of 4 (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.85). The proportion of deaths caused by sudden death versus pump-failure death decreased from a ratio of 7:1 with a SHFM score of 0 to a ratio of 1:2 with a SHFM score of 4 (P trend <0.001).

Conclusions--The SHFM score provides information about the likely mode of death among ambulatory heart failure patients. Investigation is warranted to determine whether such information might predict responses to or cost-effectiveness of specific medications or devices in heart failure patients.

Key words: arrhythmia • death, sudden • heart failure • mortality • prognosis

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