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Selecting patients for heart transplantation: Comparison of the Heart Failure Survival Score (HFSS) and the Seattle Heart Failure Model (SHFM)

https://doi.org/10.1016/j.healun.2011.05.012Get rights and content

Background

The Heart Failure Survival Score (HFSS) risk-stratifies patients with chronic heart failure (CHF) referred for heart transplantation using 7 parameters, including peak VO2. The Seattle Heart Failure Model (SHFM) is a 20-variable model that combines clinical, laboratory and therapeutic data. Although both models have excellent accuracy, only the HFSS was derived and validated in patients referred for transplantation, and the HFSS and SHFM have not been directly compared.

Methods

We tested the accuracy of the SHFM and compared the HFSS and SHFM in 715 patients referred for heart transplantation.

Results

Over a follow-up of 962 ± 912 days, 354 patients died or received an urgent heart transplantation or a ventricular assist device. One-year event-free survival was 89%, 72% and 60%, respectively, for the low-, medium- and high-risk HFSS strata, and 93%, 76%, and 58%, respectively, for the low-, medium- and high-risk SHFM strata. The HFSS and SHFM were modestly correlated (R = −0.48, p < 0.001). In receiver operating characteristic curve analysis, areas under the curves (AUCs) for the HFSS and SHFM were comparable (1 year: 0.72 vs 0.73; 2-year: 0.70 vs 0.74, respectively) and incremental to New York Heart Association class. The 1- and 2-year combined HFSS+SHFM AUCs were 0.77 and 0.76, respectively, significantly better than the HFSS or SHFM alone.

Conclusions

The HFSS and SHFM provide accurate and comparable risk stratification in CHF patients referred for transplantation. Combining the HFSS and SHFM improves predictive ability.

Section snippets

Study patients and data collection

Seven hundred fifteen consecutive patients with systolic heart failure referred to the Columbia University Medical Center for heart transplant evaluation underwent cardiopulmonary exercise testing and collection of variables in the HFSS and SHFM. Clinical characteristics are listed in Table 1. Review of the data was approved by the local human investigations committee.

The HFSS includes 7 parameters: resting heart rate (HR); mean blood pressure (mBP); left ventricular ejection fraction (LVEF);

Baseline characteristics and outcomes

The clinical characteristics and outcomes are listed in Table 1. The mean HFSS was 8.04 ± 0.89 and the mean SHFM score was 0.822 ± 0.933. The HFSS and SHFM were modestly correlated (R = −0.48, p < 0.001; Figure 1A), but more so than the peak VO2 alone vs SHFM (R = −0.36, p < 0.001; Figure 1B).

During a mean follow-up of 962 ± 912 days, 354 outcome events (49.5%) occurred; 170 patients underwent urgent heart transplantation, 148 patients died, 36 received LVAD implantation, 35 patients underwent

Discussion

We have presented two novel findings in a CHF population referred for heart transplantation: (1) the SHFM and HFSS are similarly strong; and (2) combining the SHFM and HFSS improves predictive power. We have also shown that the SHFM is valid for transplant selection, which was previously not established.11, 17

Disclosure statement

This work was supported by grants from the Stockholms Läns Landsting and the Swedish Heart–Lung Foundation, Stockholm, Sweden (to L.H.L.); the Division of Research Resources, General Clinical Research Centers Program, National Institutes of Health (5 MO1 RR00645), Bethesda, MD; the Foundation for Cardiac Therapies (FACT Fund), New York, NY; and the Altman Fund, New York, NY (to D.M.). None of the authors have any conflicts of interest to disclose.

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