Validation of Seattle Heart Failure Model for mortality risk prediction in patients treated with cardiac resynchronization therapy

AIMS: Survival prediction by the Seattle Heart Failure Model (SHFM) of patients treated with cardiac resynchronization therapy (CRT) remains ill defined. The performance of the SHFM in this clinical setting was therefore evaluated. METHODS AND RESULTS: Data from 1309 consecutive CRT patients (five centres) were collected retrospectively; 1139 of these patients were considered for analysis. Three-hundred and seven deaths occurred over 40.1 months (interquartile range 25.2-60.0 months; mean event rate 9.7%/year; survival of 89, 81, and 64% at 1, 2, and 5 years). Kaplan-Meier event-free survival analysis stratified according to tertile of SHFM score was significant (log rank test P < 0.001). High-risk tertile (T1) survival was 82, 67, and 46% at 1, 2, and 5 years, respectively. Observed compared with SHFM-predicted survival was 0.11 vs. 0.08, 0.19 vs. 0.16, and 0.36 vs. 0.36, at 1, 2, and 5 years. Model discrimination by c-statistic was 0.64; the logistic models' area under the receiver operating characteristic curve (AUC-ROC) of risk tertiles was 0.66, 0.68, and 0.67, at 1, 2, and 5 years. Compared with the other two groups, T1 was globally more compromised. Within the T1 group, independent predictors of death were male gender, ischaemic heart failure aetiology, lower body weight, and CRT pacemaker. CONCLUSIONS: SHFM performance was found to be modest, tending to overestimate survival. However, SHFM identified a high-risk, globally more compromised patient subgroup, hence supporting a comprehensive approach, which should include nutritional, metabolic, and immunological aspects, as well as defibrillator back-up

Global variations in heart failure etiology, management, and outcomes

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper–middle-income, lower–middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a β-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper–middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower–middle-income countries (39.5%) (P &lt; .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper–middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower–middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper–middle-income countries (ratio = 2.4), similar in lower–middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper–middle-income countries (9.7%), then lower–middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower–middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally