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

https://doi.org/10.1016/j.healun.2010.05.002Get rights and content

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.

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.

References (20)

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