Predictive value of the Seattle Heart Failure Model in
patients undergoing left ventricular assist device
placement
Eric S. Ketchum, MD,
a
Alec J. Moorman, MD,
a
Daniel P. Fishbein, MD,
a
Nahush A. Mokadam, MD,
b
Edward D. Verrier, MD,
b
Gabriel S. Aldea, MD,
b
Shauna Andrus, BSN, RN,
b
Kenneth W. Kenyon, PharmD,
a
and Wayne C. Levy, MD
a
From the Divisions of
a
Cardiology and
b
Cardiothoracic Surgery, University of Washington, Seattle, Washington.
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.
J Heart Lung Transplant 2010;29:1021–5
© 2010 International Society for Heart and Lung Transplantation. All rights reserved.
KEYWORDS:
heart failure;
prognosis;
transplant;
ventricular assist
devices;
Seattle Heart Failure
Model
Heart failure hospitalizations have more than doubled in
the last two decades to over 1 million admissions annually,
whereas both survival and the cost of care of heart failure
patients have increased significantly.
1
For patients with
heart failure refractory to optimal medical management,
transplantation has been an option for several decades. Un-
fortunately, there has been a worsening imbalance between
the number of patients listed for transplant and the number
of donor hearts.
2
Ventricular assist devices have increas-
ingly become an option for both prolonging survival as a
bridge to heart transplantation
3
and as a definitive destina-
tion therapy in the terminally ill heart failure patient not
eligible for transplant.
4
The American College of Cardiol-
ogy and American Heart Association (ACC/AHA) sug-
gested that a predicted mortality of 50% at 1 year is an
appropriate threshold for consideration of placement of an
LVAD.
5
Reprint requests: Wayne C. Levy, MD, Division of Cardiology, Uni-
versity of Washington, Box 356422, 1959 NE Pacific Street, Seattle, WA
98177. Telephone: 206-221-4507. Fax: 206-221-6835.
E-mail address: levywc@uw.edu
http://www.jhltonline.org
1053-2498/$ -see front matter © 2010 International Society for Heart and Lung Transplantation. All rights reserved.
doi:10.1016/j.healun.2010.05.002