title: Application of the Seattle Heart Failure Model in ambulatory patients presented to an advanced heart failure therapeutics committee.
abstract: BACKGROUND
  We sought to assess the predictive value of the Seattle Heart Failure Model (SHFM) when applied to ambulatory patients with advanced heart failure (HF) presented to an advanced HF therapeutics committee at a tertiary care US institution.
  
  
  RESULTS
  We evaluated model discrimination and calibration in 215 consecutive ambulatory patients who were presented to the Cleveland Clinic advanced HF therapeutics committee between 2004 to 2007 for evaluation for advanced options including transplantation and ventricular assist device (VAD). Analyses were stratified by committee decision (not listed versus listed United Network of Organ Sharing [UNOS] Status 2). Eighty-five percent had 1 or no missing SHFM variables. The primary outcome was a composite of all-cause mortality, VAD, or urgent (UNOS Status 1) transplantation. During a median follow-up of 24 months, 68 died, 18 received VAD support, and 81 underwent heart transplantation. Discrimination was modest both for those not listed (c-index, 0.683 at 1 year and 0.648 at 2 years), and for those listed UNOS status 2 (c-index, 0.629 at 1 year and 0.628 at 2 years). Calibration was acceptable among those patients not listed for heart transplantation but with substantial underestimation of risk (ie, overestimation of survival free of VAD or urgent transplantation) among UNOS status 2 patients.
  
  
  CONCLUSIONS
  In ambulatory patients presented to an advanced HF therapeutics committee for evaluation for heart transplantation, the SHFM offers modest discrimination of risk for the primary composite outcome of mortality, VAD, or urgent transplantation, with underestimation of risk in those patients listed for nonurgent transplantation. Interpretation of risk prediction by the SHFM in this patient population must be done with caution.
authors.affiliation: Section of Heart Failure and Cardiac Transplant Medicine, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
authors.forename: Eiran Z
authors.initials: EZ
authors.lastname: Gorodeski
authors.forename: Eric C
authors.initials: EC
authors.lastname: Chu
authors.forename: Chen H
authors.initials: CH
authors.lastname: Chow
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
authors.forename: Eileen
authors.initials: E
authors.lastname: Hsich
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D000046:Academic Medical Centers; D002138:Calibration; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010045:Outpatients; D010606:Pharmacy and Therapeutics Committee; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods