Prediction of mode of death in heart failure the seattle heart failure model

被引:228
作者
Mozaffarian, Dariush
Anker, Stefan D.
Anand, Inder
Linker, David T.
Sullivan, Mark D.
Cleland, John G. F.
Carson, Peter E.
Maggioni, Aldo P.
Mann, Douglas L.
Pitt, Bertram
Poole-Wilson, Philip A.
Levy, Wayne C.
机构
[1] Harvard Univ, Sch Med, Boston, MA 02115 USA
[2] Harvard Univ, Sch Publ Hlth, Boston, MA 02115 USA
[3] Charite, Berlin, Germany
[4] Univ Minnesota, Minneapolis, MN USA
[5] Univ Washington, Seattle, WA 98195 USA
[6] Castle Hill Hosp, Kingston Upon Hull, Yorks, England
[7] Vet Adm Med Ctr, Washington, DC 20422 USA
[8] Italian Assoc Hosp Cardiologists, Res Ctr, Florence, Italy
[9] Baylor Coll Med, Houston, TX 77030 USA
[10] Houston Vet Adm, Houston, TX 77030 USA
[11] Univ Michigan, Ann Arbor, MI 48109 USA
[12] Imperial Coll, Sch Med, London, England
关键词
arrhythmia; death; sudden; heart failure; mortality; prognosis;
D O I
10.1161/CIRCULATIONAHA.106.687103
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background - Prognosis and mode of death in heart failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive failure of cardiac function (pump failure). Prediction of mode of death may facilitate decisions about specific medications or devices. Methods and Results - We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in heart failure, to assess the mode of death in 10 538 ambulatory patients with New York Heart Association class II to IV heart failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16 735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P < 0.001 for all comparisons; 1-year area under the receiver operating curve, 0.68). Stratification of risk of pump-failure death was even more pronounced, with a 4-fold higher risk with a score of 1, a 15-fold higher risk with a score of 2, a 38-fold higher risk with a score of 3, and an 88-fold higher risk with a score of 4 (P < 0.001 for all comparisons; 1-year area under the receiver operating curve, 0.85). The proportion of deaths caused by sudden death versus pump-failure death decreased from a ratio of 7:1 with a SHFM score of 0 to a ratio of 1:2 with a SHFM score of 4 (P trend < 0.001). Conclusions - The SHFM score provides information about the likely mode of death among ambulatory heart failure patients. Investigation is warranted to determine whether such information might predict responses to or cost-effectiveness of specific medications or devices in heart failure patients.
引用
收藏
页码:392 / 398
页数:7
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