Abstract 134: Influence of Predictive Modeling in Implementing Optimal Heart Failure Therapy in Inpatient setting
Background: A gap remains between evidence-based guidelines in the treatment of heart failure and current pharmacologic and device therapy. The Seattle Heart Failure Model is an accurate predictive tool that allows the clinician to quantitatively assess the influence of pharmacologic and device therapy on heart failure that has been validated in outpatient setting. We attempt to use the Seattle Heart Failure Model in optimizing the heart failure therapy.
Methods: We examined 405 patients’ charts who were admitted with a diagnosis of acute systolic heart failure or acute on chronic systolic heart failure with left ventricular ejection fraction ≤ 40%. Twenty-one data elements were entered into the Seattle Heart Failure Model to create a survival estimate before and after implementation of interventions known to be beneficial, both pharmacologic (addition of ACE/ARB, statin, β-blocker, aldosterone blocker) and device-based (consideration for AICD, BiV pacer, BiV ICD).
Results: The mean age of the population examined was 77 ± 9 years. The cohort was comprised of 72 % males, mean weight 89 ± 22.5kg, with NYHA class 2.4 ± 0.6 symptoms. Ischemic etiology was identified in 86% with a mean left ventricular EF of 29.8 ± 9 %. Laboratory data included mean Hgb 10.1 ±1.5g/dL with 15 ± 8% lymphocytes, mean total cholesterol of 176 ± 42mg/dL and mean sodium of 133 ± 3.5mmol/L. The one year all-cause mortality rates were 19.5 % reflecting advanced heart failure population. In the 405 patients examined, we were able to alter therapy (medical or device) in 86%. This included advancement of medical therapy in 56%, consideration for device referral in 11%, or both (medical therapy and device referral) in 19 %. This augmentation of therapy resulted in an increase in estimated mean life expectancy from 6.6 years to 9.6 years (p < 0.001).
Conclusion: Use of the Seattle Heart Failure Model significantly helps in intensification of heart failure therapy when applied at time of discharge or in first follow up visit post discharge.
Author Disclosures: H. Prasad: None. G. Choudhary: None. A. Fahad: None. D. Stapleton: None.
- © 2014 by American Heart Association, Inc.