Predictive value of the Seattle Heart Failure Model in patients undergoing left ventricular assist device placement

Ketchum, Eric S.; Moorman, Alec J.; Fishbein, Daniel P.; Mokadam, Nahush A.; Verrier, Edward D.; Aldea, Gabriel S.; Andrus, Shauna; Kenyon, Kenneth W.; Levy, Wayne C.

doi:10.1016/j.healun.2010.05.002

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 29, Issue 9 , Pages 1021-1025, September 2010

Predictive value of the Seattle Heart Failure Model in patients undergoing left ventricular assist device placement

Eric S. Ketchum, MD
- Division of Cardiology, University of Washington, Seattle, Washington
Alec J. Moorman, MD
- Division of Cardiology, University of Washington, Seattle, Washington
Daniel P. Fishbein, MD
- Division of Cardiology, University of Washington, Seattle, Washington
Nahush A. Mokadam, MD
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
Edward D. Verrier, MD
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
Gabriel S. Aldea, MD
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
Shauna Andrus, BSN, RN
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
Kenneth W. Kenyon, PharmD
- Division of Cardiology, University of Washington, Seattle, Washington
Wayne C. Levy, MD
- Division of Cardiology, University of Washington, Seattle, Washington
- Reprint requests: Wayne C. Levy, MD, Division of Cardiology, University of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA 98177. Telephone: 206-221-4507. Fax: 206-221-6835

published online 17 June 2010.

Background

Left ventricular assist devices (LVADs) are increasingly used in advanced heart failure patients. Despite proven efficacy, optimal timing of LVAD implantation is not well defined.

Methods

Patients receiving an LVAD were prospectively recorded. Laboratory and clinical data were extracted and used to calculate the predicted survival with medical therapy using the Seattle Heart Failure Model (SHFM). This was compared with observed survival, hospital length of stay and timeliness of discharge.

Results

We identified 104 patients. Survival with an LVAD vs SHFM predicted survival was 69% vs 11% at 1 year, corresponding to a hazard ratio of 0.17 (p < 0.0001). SHFM-estimated 1-year survival with medical therapy increased from 4% in 1997 to 2004 to 25% in 2007–2008 (p < 0.0001). Subgroup analysis of higher vs lower risk LVAD patients showed observed 1-year survival of 83% vs 57% (p = 0.04). The lower risk group had a shorter length of stay (46 vs 75 days, p = 0.03), along with higher rates of discharge prior to transplant (88% vs 61%, p = 0.01) and discharge within 60 days of LVAD placement (77% vs 52%, p = 0.03).

Conclusions

The SHFM allows prediction of important features of a patient's hospital course post-operatively, including length of stay and 1-year survival. Given evidence of improved survival and shorter hospital stay in lower risk patients, earlier LVAD placement based on a prediction model like the SHFM should be considered in advanced heart failure patients. The SHFM may have utility as a virtual control arm for single-arm LVAD trials.

Keywords: heart failure, prognosis, transplant, ventricular assist devices, Seattle Heart Failure Model