title: Associations between seattle heart failure model scores and medical resource use and costs: findings from HF-ACTION.
abstract: BACKGROUND
  Prognostic models, such as the Seattle Heart Failure Model (SHFM), have been developed to predict patient survival. The extent to which they predict medical resource use and costs has not been explored. In this study, we evaluated relationships between baseline SHFM scores and 1-year resource use and costs using data from a clinical trial.
  
  
  RESULTS
  We applied generalized linear models to examine the relative impact of a 1-unit increase in SHFM scores on counts of medical resource use and direct medical costs at 1 year of follow-up. Of 2331 randomized patients, 2288 (98%) had a rounded integer SHFM score between -1 and 2, consistent with predicted 1-year survival of 98% and 74%, respectively. At baseline, median age was 59 years, 28% of patients were women, and nearly two-thirds of the cohort had New York Heart Association class II heart failure and one-third had class III heart failure. Higher SHFM scores were associated with more hospitalizations (rate ratio per 1-unit increase, 1.86; P < .001), more inpatient days (2.30; P < .001), and higher inpatient costs (2.28; P < .001), outpatient costs (1.54; P < .001), and total medical costs (2.13; P < .001).
  
  
  CONCLUSIONS
  Although developed to predict all-cause mortality, SHFM scores also predict medical resource use and costs.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.affiliation: University of Washington School of Medicine, Seattle, Washington.
authors.forename: Wayne C
authors.initials: WC
authors.lastname: Levy
authors.affiliation: Department of Medicine, Duke University School of Medicine, Durham, North Carolina; University of Glasgow, Glasgow, Scotland.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Neilson
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Ellis
authors.affiliation: Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. Electronic address: shelby.reed@duke.edu.
authors.forename: Shelby D
authors.initials: SD
authors.lastname: Reed
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D003365:Costs and Cost Analysis; D005081:Exercise Therapy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006295:Health Resources / Q000191:economics*; D006304:Health Status; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Health care costs; health resources; health status; heart failure; questionnaires; risk assessment