Abstract 14086: Seattle Heart Failure Model Identifies Patients Most Likely to Have Improved Survival With Cardiac Resynchronization Therapy Defibrillators - An NCDR Analysis
Introduction: In the Sudden Cardiac Death in Heart Failure Trial, lower Seattle Heart Failure Model (SHFM) risk was associated with an increased survival benefit with implantable cardioverter defibrillators (ICDs), but the impact of SHFM risk on the survival benefit with cardiac resynchronization therapy defibrillators (CRT-D) remains to be determined.
Hypothesis: Increasing SHFM risk will be associated with a greater impact of CRT-D on survival in the National Cardiovascular Data Registry (NCDR) ICD Registry.
Methods: The study cohort consisted of patients with CRT-D from the NCDR ICD Registry with current criteria for CRT-D implantation. The control cohort consisted of patients from the University of Washington Registry, Italian Heart Failure Registry, Swedish Heart Failure Registry, COMET, Val-HeFT, and PRAISE trials who met standard criteria for CRT-D but who did not receive CRT-D. Multivariable logistic regression with receiver operating characteristic (ROC) analysis and multivariable Cox proportional hazards regression were used to determine associations between SHFM and survival.
Results: The 38,642 CRT-D patients were 69.6 ± 10.9 years old. The AUC for overall survival with the SHFM score alone was 0.713 [95% CI 0.694-0.731], which compared favorably to the AUC for the model with all covariates (ROC 0.698 [95% CI 0.679-0.717]). Survival over 5 years in CRT-D patients decreased with increasing SHFM quintile: 90% (1), 80% (2), 70% (3), 59% (4), and 42% (5) (P<0.0001). CRT-D had the greatest impact on survival in patients in higher SHFM risk quintiles (Figure; HR 0.463 [95% CI 0.330-0.649] for quintile 4 versus HR 0.803 [95% CI 0.429-1.503] for quintile 1).
Conclusions: The SHFM is strongly associated with overall survival in a real-world CRT-D cohort. Patients with higher SHFM risk have decreased survival overall, but also the greatest survival benefit versus controls, suggesting that the impact of CRT-D on survival is greatest in the highest risk patients.
Author Disclosures: K.C. Bilchick: None. A. Cheng: Employment; Significant; Medtronic. Y. Wang: None. J. Curtis: Employment; Significant; Centers for Medicare & Medicaid Services, National Cardiovascular Data Registry. Ownership Interest; Significant; Medtronic. K. Dharmarajan: Employment; Significant; Centers for Medicare & Medicaid Services. Consultant/Advisory Board; Modest; Clover Health. W. Levy: Research Grant; Modest; Amgen, Resmed, Novartis. Consultant/Advisory Board; Modest; Novartis, St. Jude Medical, GE Healthcare, Abbott, Biotronik.
- © 2016 by American Heart Association, Inc.