Original clinical sciencePredictive value of the Seattle Heart Failure Model in patients undergoing left ventricular assist device placement
Section snippets
Methods
Patients undergoing LVAD placement are prospectively collected in a limited database. A review of patients receiving an LVAD between 1997 and 2008 was undertaken after approval by the institutional review board of the University of Washington. The sole inclusion criterion was a diagnosis of heart failure for at least 30 days prior to the implantation of an LVAD. Patients receiving an LVAD as a temporary or peri-operative stabilizing measure (“bridge to re-evaluation”) were excluded. Data were
Results
One hundred fifty-four patients received an LVAD during the study period; 104 met the inclusion criteria. Ninety-three percent of the patients received the device as a bridge to transplantation, whereas 7% received the device as destination therapy. Baseline characteristics of the population are shown in Table 1. Average age was 53 years, with a mean ejection fraction of 18%. All patients were NYHA Stage IV, with 46% having an ischemic etiology to their heart failure. Fifty-three percent had an
Discussion
Emerging data have continued to show the efficacy of LVAD therapy in the treatment of refractory heart failure: the original REMATCH data comparing destination LVAD with medical management demonstrated a 52% 1-year survival in the LVAD group as compared with 25% survival in the medically managed group,12 whereas subsequent post–end-point analysis confirmed continuing improved survival in the LVAD treatment group.13 Data from the INTERMACS self-reported database of 75 centers implanting VADs
Disclosure statement
W.L. has received research grants from Thoratec and HeartWare. The University of Washington Technology Transfer has received licensing fees for use of the Seattle Heart Failure Model.
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Cited by (51)
Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device
2022, JACC: Heart FailureCitation Excerpt :The HM3RS could be used to discuss the degree of increase in expected survival when compared with medical therapy alone. As an example, one could apply available risk scores such as the MAGGIC score or the Seattle Heart Failure Model and compare expected prolongation in survival with implantation of the HM3 LVAD.15,34 In such a scenario, it appears that even if a patient is assigned to lower-than-average survival with an LVAD, there is substantial benefit when the risk is calculated vs medical therapy (Supplemental Figure 4).
Left Ventricular Device Implantation Impacts on Hospitalisation Rates, Length of Stay and Out of Hospital Time
2018, Heart Lung and CirculationCitation Excerpt :However, implanting VADs in this population runs the risk of exposing the recipients to increased rates of hospitalisation compared with those experienced at an earlier stage in the heart failure trajectory. Appropriate patient selection for VAD and the predictors of poor outcomes following implantation remain important avenues for research [28–32], and a high level of multi-disciplinary clinical expertise needs to be brought to bear during this phase of patient care and decision making. The increased range of hospitalisation that appears in the first year post VAD (Figure 2), is in the context of extremely poor pre-implant prognoses, and underlines the importance of patient selection and informed consent in the setting of higher risk scenarios.
Global Outcome in Patients With Left Ventricular Assist Devices
2017, American Journal of CardiologyFrom statistical significance to clinical relevance: A simple algorithm to integrate brain natriuretic peptide and the Seattle Heart Failure Model for risk stratification in heart failure
2016, Journal of Heart and Lung TransplantationMortality prediction using a modified Seattle Heart Failure Model may improve patient selection for ventricular tachycardia ablation
2015, American Heart JournalCitation Excerpt :The endpoint for the model was death, LVAD implantation, or heart transplantation—although >98% events in the original cohorts were deaths. Subsequently, the discrimination and calibration of the SHFM were further validated in patients with more advanced heart failure.20,24,26 In 2013, the SHFM was updated to allow its application to higher risk hospitalized patients by including inotropes, intraaortic balloon pump, ventilator, ultrafiltration, and incorporation of newer LVADs.
Fully Magnetically Levitated Left Ventricular Assist System for Treating Advanced HF A Multicenter Study
2015, Journal of the American College of Cardiology