Can the Seattle heart failure model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy?
BACKGROUND
According to results of the REMATCH trial, left ventricular assist device therapy in patients with severe heart failure has resulted in a 48% reduction in mortality. A decision tool will be necessary to aid in the selection of patients for destination left ventricular assist devices (LVADs) as the technology progresses for implantation in ambulatory Stage D heart failure patients. The purpose of this analysis was to determine whether the Seattle Heart Failure Model (SHFM) can be used to risk-stratify heart failure patients for potential LVAD therapy.


METHODS
The SHFM was applied to REMATCH patients with the prospective addition of inotropic agents and intra-aortic balloon pump (IABP) +/- ventilator.


RESULTS
The SHFM was highly predictive of survival (p = 0.0004). One-year SHFM-predicted survival was similar to actual survival for both the REMATCH medical (30% vs 28%) and LVAD (49% vs 52%) groups. The estimated 1-year survival with medical therapy for patients in REMATCH was 30 +/- 21%, but with a range of 0% to 74%. The 1- and 2-year estimated survival was </=50% for 81% and 98% of patients, respectively. There was no evidence that the benefit of the LVAD varied in the lower vs higher risk patients.


CONCLUSIONS
The SHFM can be used to risk-stratify end-stage heart failure patients, provided known markers of increased risk are included such inotrope use and IABP +/- ventilator support. The SHFM may facilitate identification of high-risk patients to evaluate for potential LVAD implantation by providing an estimate of 1-year survival with medical therapy.
Levy
Wayne C
WC
University of Washington, Seattle, 98177, USA. levywc@u.washington.edu
Mozaffarian
Dariush
D
Linker
David T
DT
Farrar
David J
DJ
Miller
Leslie W
LW
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D015233:Models, Statistical; D018579:Patient Selection; D018570:Risk Assessment