西雅图心力衰竭模型在接受左心室辅助装置植入术患者中的预测价值。
Predictive value of the Seattle Heart Failure Model in patients undergoing left ventricular assist device placement.
机构信息
Division of Cardiology, University of Washington, Seattle, Washington 98177, USA.
出版信息
J Heart Lung Transplant. 2010 Sep;29(9):1021-5. doi: 10.1016/j.healun.2010.05.002. Epub 2010 Jun 16.
BACKGROUND
Left ventricular assist devices (LVADs) are increasingly used in advanced heart failure patients. Despite proven efficacy, optimal timing of LVAD implantation is not well defined.
METHODS
Patients receiving an LVAD were prospectively recorded. Laboratory and clinical data were extracted and used to calculate the predicted survival with medical therapy using the Seattle Heart Failure Model (SHFM). This was compared with observed survival, hospital length of stay and timeliness of discharge.
RESULTS
We identified 104 patients. Survival with an LVAD vs SHFM predicted survival was 69% vs 11% at 1 year, corresponding to a hazard ratio of 0.17 (p < 0.0001). SHFM-estimated 1-year survival with medical therapy increased from 4% in 1997 to 2004 to 25% in 2007-2008 (p < 0.0001). Subgroup analysis of higher vs lower risk LVAD patients showed observed 1-year survival of 83% vs 57% (p = 0.04). The lower risk group had a shorter length of stay (46 vs 75 days, p = 0.03), along with higher rates of discharge prior to transplant (88% vs 61%, p = 0.01) and discharge within 60 days of LVAD placement (77% vs 52%, p = 0.03).
CONCLUSIONS
The SHFM allows prediction of important features of a patient's hospital course post-operatively, including length of stay and 1-year survival. Given evidence of improved survival and shorter hospital stay in lower risk patients, earlier LVAD placement based on a prediction model like the SHFM should be considered in advanced heart failure patients. The SHFM may have utility as a virtual control arm for single-arm LVAD trials.
背景
左心室辅助装置（LVAD）在晚期心力衰竭患者中越来越多地使用。尽管已证实其疗效，但 LVAD 植入的最佳时机尚未明确。
方法
前瞻性记录接受 LVAD 的患者。提取实验室和临床数据，并使用西雅图心力衰竭模型（SHFM）计算药物治疗的预测生存率。将此与观察到的生存率、住院时间和出院及时性进行比较。
结果
我们确定了 104 名患者。LVAD 与 SHFM 预测生存率的比较结果为：1 年时，LVAD 组为 69%，SHFM 组为 11%，相应的风险比为 0.17（p<0.0001）。SHFM 估计的 1 年药物治疗生存率从 1997 年至 2004 年的 4%增加到 2007 年至 2008 年的 25%（p<0.0001）。对高风险和低风险 LVAD 患者的亚组分析显示，观察到的 1 年生存率分别为 83%和 57%（p=0.04）。低风险组的住院时间更短（46 天 vs 75 天，p=0.03），且在移植前出院率更高（88% vs 61%，p=0.01），在 LVAD 植入后 60 天内出院率更高（77% vs 52%，p=0.03）。
结论
SHFM 可预测患者术后住院期间的重要特征，包括住院时间和 1 年生存率。鉴于低风险患者的生存率提高和住院时间缩短，应根据 SHFM 等预测模型考虑提前进行 LVAD 植入。SHFM 可作为单臂 LVAD 试验的虚拟对照臂。
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