title: Can the Seattle heart failure model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy?
abstract: 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.
authors.affiliation: University of Washington, Seattle, 98177, USA. levywc@u.washington.edu
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
authors.forename: Dariush
authors.initials: D
authors.lastname: Mozaffarian
authors.forename: David T
authors.initials: DT
authors.lastname: Linker
authors.forename: David J
authors.initials: DJ
authors.lastname: Farrar
authors.forename: Leslie W
authors.initials: LW
authors.lastname: Miller
mesh_terms: 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