title: Validation of Seattle Heart Failure Model for mortality risk prediction in patients treated with cardiac resynchronization therapy.
abstract: OBJECTIVE
  Survival prediction by the Seattle Heart Failure Model (SHFM) of patients treated with cardiac resynchronization therapy (CRT) remains ill defined. The performance of the SHFM in this clinical setting was therefore evaluated.
  
  
  RESULTS
  Data from 1309 consecutive CRT patients (five centres) were collected retrospectively; 1139 of these patients were considered for analysis. Three-hundred and seven deaths occurred over 40.1 months (interquartile range 25.2-60.0 months; mean event rate 9.7%/year; survival of 89, 81, and 64% at 1, 2, and 5 years). Kaplan-Meier event-free survival analysis stratified according to tertile of SHFM score was significant (log rank test P < 0.001). High-risk tertile (T1) survival was 82, 67, and 46% at 1, 2, and 5 years, respectively. Observed compared with SHFM-predicted survival was 0.11 vs. 0.08, 0.19 vs. 0.16, and 0.36 vs. 0.36, at 1, 2, and 5 years. Model discrimination by c-statistic was 0.64; the logistic models' area under the receiver operating characteristic curve (AUC-ROC) of risk tertiles was 0.66, 0.68, and 0.67, at 1, 2, and 5 years. Compared with the other two groups, T1 was globally more compromised. Within the T1 group, independent predictors of death were male gender, ischaemic heart failure aetiology, lower body weight, and CRT pacemaker.
  
  
  CONCLUSIONS
  SHFM performance was found to be modest, tending to overestimate survival. However, SHFM identified a high-risk, globally more compromised patient subgroup, hence supporting a comprehensive approach, which should include nutritional, metabolic, and immunological aspects, as well as defibrillator back-up.
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Scopigni
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
authors.forename: Maurizio
authors.initials: M
authors.lastname: Landolina
authors.forename: Stefano
authors.initials: S
authors.lastname: Ghio
authors.forename: Massimo
authors.initials: M
authors.lastname: Tritto
authors.forename: Leonardo
authors.initials: L
authors.lastname: Calò
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D002423:Cause of Death; D003131:Combined Modality Therapy / Q000401:mortality; D015897:Comorbidity; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D013557:Switzerland; D006113:United Kingdom