Utility of the Seattle Heart Failure Model in Patients With Advanced Heart Failure
Utility of the Seattle Heart Failure Model in Patients With Advanced Heart Failure
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DOI：
10.1016/j.jacc.2008.10.023
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发表时间：
2009-01-27
影响因子：
24
通讯作者：
Butler, Javed
中科院分区：
文献类型：
--
作者：
Kalogeropoulos, Andreas P.;Georgiopoulou, Vasiliki V.;Butler, Javed
目的本研究的目的是验证西雅图心力衰竭模型（SHFM）在晚期心力衰竭（HF）患者中的适用性。背景SHFM主要是从临床试验数据库中开发的，并从已发表的数据中推断干预的益处。方法我们在445例晚期HF患者中评估SHFM的区分和校准（年龄52 +/- 12岁，68.5%男性，52.4%白色，射血分数18 +/- 8%）转诊进行心脏移植。主要终点为死亡（n = 92）、紧急移植（n = 14）或左心室辅助装置（LVAD）植入（n = 3）;仅对死亡率进行二次分析。结果患者接受最佳治疗（血管紧张素II调节92.8%，β受体阻滞剂91.5%，醛固酮拮抗剂46.3%），71.0%有植入式装置（除颤器30.4%，双心室起搏器3.4%，组合37.3%）。在中位随访21个月期间，109例患者（24.5%）发生了事件。尽管区分度足够（c-统计量> 0.7），但SHFM总体上低估了绝对风险（1年、2年和3年时观察事件率与预测事件率分别为11.0%与9.2%、21.0%与16.6%和27.9%与22.8%）。植入器械患者的风险预测不足更为突出。SHFM在白色与黑人患者中具有不同的校准特性，导致黑人绝对风险的净低估。种族特定的重新校准提高了预测的准确性。当分析仅限于死亡率，SHFM表现出更好的performance.Conclusions在晚期HF患者中，SHFM提供了足够的歧视，但绝对风险被低估，特别是在黑人和设备的患者。当包括移植和LVAD植入作为终点时，这一点更加突出。（美国科尔心脏病学杂志2009; 53：334-42）（C）2009年美国心脏病学会基金会
Objectives The aim of this study was to validate the Seattle Heart Failure Model (SHFM) in patients with advanced heart failure (HF).Background The SHFM was developed primarily from clinical trial databases and extrapolated the benefit of interventions from published data.Methods We evaluated the discrimination and calibration of SHFM in 445 advanced HF patients (age 52 +/- 12 years, 68.5% male, 52.4% white, ejection fraction 18 +/- 8%) referred for cardiac transplantation. The primary end point was death (n = 92), urgent transplantation (n = 14), or left ventricular assist device (LVAD) implantation (n = 3); a secondary analysis was performed on mortality alone.Results Patients were receiving optimal therapy (angiotensin-II modulation 92.8%, beta-blockers 91.5%, aldosterone antagonists 46.3%), and 71.0% had an implantable device (defibrillator 30.4%, biventricular pacemaker 3.4%, combined 37.3%). During a median follow-up of 21 months, 109 patients (24.5%) had an event. Although discrimination was adequate (c-statistic > 0.7), the SHFM overall underestimated absolute risk ( observed vs. predicted event rate: 11.0% vs. 9.2%, 21.0% vs. 16.6%, and 27.9% vs. 22.8% at 1, 2, and 3 years, respectively). Risk underprediction was more prominent in patients with an implantable device. The SHFM had different calibration properties in white versus black patients, leading to net underestimation of absolute risk in blacks. Race-specific recalibration improved the accuracy of predictions. When analysis was restricted to mortality, the SHFM exhibited better performance.Conclusions In patients with advanced HF, the SHFM offers adequate discrimination, but absolute risk is underestimated, especially in blacks and in patients with devices. This is more prominent when including transplantation and LVAD implantation as an end point. (J Am Coll Cardiol 2009; 53: 334-42) (C) 2009 by the American College of Cardiology Foundation