title: Usefulness of the Seattle Heart Failure Model to identify adults with congenital heart disease at high risk of poor outcome.
abstract: Our objective was to determine whether the Seattle Heart Failure Model (SHFM) differentiates patients with adult congenital heart disease (ACHD) at high versus low risk for cardiovascular outcomes and poor exercise capacity. The ACHD population is growing and presents increasingly for care in the community and at tertiary centers. Few strategies exist to identify the patients with ACHD at high risk for heart failure and mortality.We studied 153 adults with transposition of the great arteries, Ebstein anomaly, tetralogy of Fallot, double outlet right ventricle, and single ventricle from 2 ACHD centers. The primary outcome was cardiovascular death, with a secondary composite outcome of death, transplant, ventricular assist device, cardiovascular admission, and treatment for arrhythmia. We defined risk groups based on SHFM 5-year predicted survival: high (predicted survival <70%), intermediate (70% to 85%), and low risk (>85%). Ten patients had the primary outcome of death, and 46 the combined end point. The hazard of death in the SHFM high- versus the intermediate-risk group was 7.09 (95% confidence interval 1.5 to 33.4, p = 0.01; no deaths in the low-risk group) and the hazard of the composite outcome between the high- versus low-risk group was 6.64 (95% confidence interval 2.5 to 17.6, p = 0.0001). Kaplan-Meier survival analysis showed greater probability of all-cause mortality (p = 0.003) in the high-risk group. In conclusion, the SHFM can help identify subjects with ACHD at risk for adverse outcome and poor cardiopulmonary efficiency. This may add to the care of patients with ACHD in the community and streamline care at tertiary centers.
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Ada
authors.initials: A
authors.lastname: Stefanescu
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Macklin
authors.affiliation: Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Elaine
authors.initials: E
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Dudzinski
authors.affiliation: Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jacob
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.affiliation: Division of Cardiology, Yale University Medical Center, New Haven, Connecticut.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jacoby
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Doreen
authors.initials: D
authors.lastname: DeFaria Yeh
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Lewis
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Richard
authors.initials: R
authors.lastname: Liberthson
authors.affiliation: Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: George
authors.initials: G
authors.lastname: Lui
authors.affiliation: Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: abhatt@mgh.harvard.edu.
authors.forename: Ami B
authors.initials: AB
authors.lastname: Bhatt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017079:Exercise Tolerance; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D010101:Oxygen Consumption; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult