Abstract 2307: Seattle Heart Failure Model Overestimates Time to Mortality in Patients Referred for Heart Transplantation

Abstract

Background : Accurate determination of time to death in advanced heart failure (HF) patients is critical for appropriate transplant candidate selection. Recently, Seattle Heart Failure Model (SHFM) was introduced to assess HF prognosis, however it was developed from a general HF population and its accuracy in advanced HF patients has not been reported. Methods : We collected data on 51 advanced HF patients referred for transplant evaluation who died during follow-up (mean age 57.4±17.5 years, 70.1% male, and 56.9% white). Time to death prediction by the SHFM was assessed by plotting actuarial survival time vs. model error (=predicted-actual). Gender and race based stratified analysis were also performed. Results : Median ejection fraction was 0.15 (25%–75%: 0.10 – 0.25), heart rate was 87±19 bpm, and systolic blood pressure was 117±22 mmHg. Overall 90.2% patients were on ACE inhibitor or angiotensin receptor blockers, 82.4% on beta-blockers, and 74.6% had a defibrillator implanted. Median expected survival by the SHFM was 6.4 (3.8 –9.7) years. Median actual survival was 2.0 (1.1–3.9) years. Residual analysis showed that the SHFM overestimated survival by 3.8 (1.5– 6.5) years, p<0.001, Fig 1 . Overall 86.3% patients lived shorter than projected survival. The SHFM overestimated survival more in black vs. white patients (4.5 years, 25%–75%: 2.3–7.9 years in blacks vs. 2.8 years, 25%–75%: 0.7– 6.0 years in whites, p=0.07). No significant gender differences were noted. Conclusion : The SHFM significantly overestimates survival in advanced HF patients referred for transplantation, especially in blacks. Further studies are needed to modify and validate the SHFM in these patients.