Predicting the Mode of Death for Heart Failure Patients. July 29, 2007

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July 29, 2007 By Farhad Abtahian, M.D. Ph.D. [1]

The Seattle Heart Failure Model (SHFM), which has been used to predict mortality in heart failure [1], may also predict the mode of death [2]. Death from heart failure can occur either suddenly (usually due to ventricular arrhythmia) or more slowly secondary to progressive pump failure. An ability to predict which mode of death is more likely in a given patient would allow for a more rational and tailored decision on which medical and/or device therapies to pursue. A new study, published in the journal Circulation, has assessed the SHFM as a possible tool in predicting mode of death in heart failure patients.

Using data from 6 prospective trials that enrolled over ten thousand patients, the authors tested the capacity of the SHFM to predict the mode of death (either sudden death or death by progressive pump failure) in an ambulatory patient population. Compared to patients with a SHFM score of 0, patients with scores of 1, 2, and 3-4 had a 1.5, 3, or 7-fold higher risk of sudden death, respectively. The risk of death by pump failure with increasing SHFM score was more striking. Patients with scores of 4 had a 88-fold higher risk of death when compared to patients with scores of 0. The proportion of deaths caused by sudden death versus pump failure death decreased from 7:1 with a SHFM score of 0 to 1:2 with a score of 4. In addition to relative risk, the SHFM also predicted the absolute risks of the two modes of death. Both the relative risks and absolute risks predicted by the SHFM were consistent across different patient subgroups including within categories of NYHA class.

The effectiveness of the various medical and device therapies available in the treatment of heart failure depends in large part on the risks of sudden death and pump failure. For example, accurate prediction of the likelihood of sudden death could guide decisions on the use of ICDs. While the results of this study do not change clinical practice, they do suggest that with further research it may be possible to accurately predict mode of death in heart failure patients. As the authors note, an important next step will be to assess the capacity of the SHFM to predict the response of patients to specific interventions.