The Seattle heart failure model - Prediction of survival in heart failure

被引:1541
作者
Levy, WC
Mozaffarian, D
Linker, DT
Sutradhar, SC
Anker, SD
Cropp, AB
Anand, I
Maggioni, A
Burton, P
Sullivan, MD
Pitt, B
Poole-Wilson, PA
Mann, DL
Packer, M
机构
[1] Univ Washington, Div Cardiol, Seattle, WA 98177 USA
[2] Brigham & Womens Hosp, Channing Lab, Boston, MA 02115 USA
[3] Harvard Univ, Sch Med, Boston, MA USA
[4] Merck Res Labs, Blue Bell, PA USA
[5] Univ London Imperial Coll Sci Technol & Med, London, England
[6] Pfizer Labs, Groton, CT USA
[7] Univ Minnesota, Minneapolis, MN USA
[8] Italian Assoc Hosp Cardiologists, Res Ctr, Florence, Italy
[9] Amgen Inc, Thousand Oaks, CA 91320 USA
[10] Univ Michigan, Ann Arbor, MI 48109 USA
[11] Baylor Coll Med, Houston, TX 77030 USA
[12] Houston Vet Affairs, Houston, TX USA
[13] Univ Texas, SW Med Ctr, Dallas, TX 75230 USA
关键词
diuretics; heart failure; hemoglobin; lymphocytes; prognosis;
D O I
10.1161/CIRCULATIONAHA.105.584102
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Heart failure has an annual mortality rate ranging from 5% to 75%. The purpose of the study was to develop and validate a multivariate risk model to predict 1-, 2-, and 3- year survival in heart failure patients with the use of easily obtainable characteristics relating to clinical status, therapy (pharmacological as well as devices), and laboratory parameters. Methods and Results - The Seattle Heart Failure Model was derived in a cohort of 1125 heart failure patients with the use of a multivariate Cox model. For medications and devices not available in the derivation database, hazard ratios were estimated from published literature. The model was prospectively validated in 5 additional cohorts totaling 9942 heart failure patients and 17 307 person-years of follow-up. The accuracy of the model was excellent, with predicted versus actual 1- year survival rates of 73.4% versus 74.3% in the derivation cohort and 90.5% versus 88.5%, 86.5% versus 86.5%, 83.8% versus 83.3%, 90.9% versus 91.0%, and 89.6% versus 86.7% in the 5 validation cohorts. For the lowest score, the 2- year survival was 92.8% compared with 88.7%, 77.8%, 58.1%, 29.5%, and 10.8% for scores of 0, 1, 2, 3, and 4, respectively. The overall receiver operating characteristic area under the curve was 0.729 ( 95% CI, 0.714 to 0.744). The model also allowed estimation of the benefit of adding medications or devices to an individual patient's therapeutic regimen. Conclusions - The Seattle Heart Failure Model provides an accurate estimate of 1-, 2-, and 3-year survival with the use of easily obtained clinical, pharmacological, device, and laboratory characteristics.
引用
收藏
页码:1424 / 1433
页数:10
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