Seattle Heart Failure Model
Predicts 1-year survival in heart failure patients. Higher scores indicate worse prognosis and lower survival rates.
Gender
Patient's gender
NYHA Functional Class
Heart failure functional class
NYHA Class I
NYHA Class II
NYHA Class III
NYHA Class IV
Implanted Device
Currently implanted cardiac device
No device
ICD
CRT
CRT-D
Current Medications
Select all medications the patient is currently taking
ACE Inhibitor
ARB
Beta-blocker
Aldosterone antagonist
Statin
Allopurinol
Laboratory Values
Seattle Heart Failure Model
The Seattle Heart Failure Model is a validated risk prediction tool that estimates 1-year survival in patients with heart failure. This model incorporates multiple clinical variables including demographics, symptoms, medications, devices, and laboratory values to provide a comprehensive assessment of prognosis.
Model Components
The Seattle Heart Failure Model evaluates the following variables:
Demographic Factors
- Age: Older age is associated with worse prognosis
- Gender: Male gender is associated with slightly worse outcomes
Clinical Factors
- NYHA Functional Class: Higher classes indicate worse prognosis
- Ejection Fraction: Lower EF is associated with worse outcomes
- Blood Pressure: Lower systolic BP indicates worse prognosis
Laboratory Values
- Serum Sodium: Hyponatremia is a strong predictor of poor outcomes
- Hemoglobin: Anemia is associated with worse prognosis
- Lymphocyte Count: Lower counts indicate worse outcomes
- Uric Acid: Elevated levels are associated with worse prognosis
- Total Cholesterol: Lower levels may indicate worse outcomes
Medications (Protective Factors)
- Beta-blockers: Strong protective effect (-0.5 points)
- ACE inhibitors/ARBs: Protective effect (-0.3 points each)
- Aldosterone antagonists: Protective effect (-0.2 points)
- Statins: Protective effect (-0.2 points)
Devices (Protective Factors)
- CRT-D: Strongest protective effect (-0.5 points)
- CRT: Moderate protective effect (-0.3 points)
- ICD: Mild protective effect (-0.2 points)
Risk Stratification and Survival Prediction
| Score | Risk Level | 1-Year Survival | Clinical Implication |
|---|---|---|---|
| ≤ 0 | Low | 95% | Excellent prognosis |
| 0.1 - 1.0 | Low-moderate | 85% | Good prognosis |
| 1.1 - 2.0 | Moderate | 70% | Moderate prognosis |
| 2.1 - 3.0 | High | 50% | Poor prognosis |
| > 3.0 | Very high | 30% | Very poor prognosis |
Clinical Applications
The Seattle Heart Failure Model is used for:
- Prognostic assessment: Estimating survival and outcomes
- Treatment decisions: Guiding intensity of therapy
- Device therapy: Risk-stratifying patients for LVAD consideration
- Transplant evaluation: Identifying candidates for heart transplantation
- Palliative care: Identifying patients who may benefit from palliative care
- Clinical trials: Patient stratification and inclusion criteria
Management Implications by Risk Level
Low Risk (Score ≤ 0)
- Survival: 95% at 1 year
- Management:
- Standard heart failure management
- Regular follow-up and monitoring
- Optimize medical therapy
- Lifestyle modifications
Low-Moderate Risk (Score 0.1-1.0)
- Survival: 85% at 1 year
- Management:
- Optimize medical therapy
- Consider device therapy if indicated
- Regular monitoring
- Cardiac rehabilitation
Moderate Risk (Score 1.1-2.0)
- Survival: 70% at 1 year
- Management:
- Intensive medical therapy
- Consider advanced heart failure evaluation
- Frequent monitoring
- Consider device therapy
High Risk (Score 2.1-3.0)
- Survival: 50% at 1 year
- Management:
- Advanced heart failure therapies
- Consider transplant evaluation
- Consider LVAD evaluation
- Palliative care consultation
Very High Risk (Score > 3.0)
- Survival: 30% at 1 year
- Management:
- Palliative care consultation
- Consider mechanical circulatory support
- End-of-life planning
- Hospice consideration
Validation and Performance
The Seattle Heart Failure Model has been extensively validated:
- Discrimination: Excellent ability to distinguish between patients with different survival outcomes
- Calibration: Well-calibrated across different populations
- External validation: Validated in multiple cohorts and populations
- Clinical utility: Shown to improve clinical decision-making
Limitations and Considerations
The model has several limitations:
- Static prediction: Does not account for changes in clinical status
- Population-based: May not apply to individual patients
- Data requirements: Requires multiple laboratory values
- Not a treatment guide: Should be used with clinical judgment
- Evolving therapies: May not reflect benefits of newer treatments
Integration with Clinical Practice
The Seattle Heart Failure Model should be used as part of a comprehensive clinical assessment:
- Combine with other risk scores and clinical judgment
- Consider patient preferences and values
- Regular reassessment as clinical status changes
- Use in shared decision-making with patients and families
- Follow institutional protocols and guidelines
Comparison with Other Risk Models
The Seattle Heart Failure Model offers several advantages:
- Comprehensive: Incorporates multiple clinical variables
- Validated: Extensively validated in multiple populations
- User-friendly: Available as online calculator
- Prognostic: Provides survival estimates
- Clinical utility: Guides treatment decisions
The Seattle Heart Failure Model continues to be a valuable tool in heart failure management, providing clinicians with objective risk stratification to guide treatment decisions and patient counseling.
References
- Levy WC, Mozaffarian D, Linker DT, et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation. 2006;113(11):1424-1433.
- Levy WC, Mozaffarian D, Linker DT, et al. Can the Seattle Heart Failure Model be used to risk-stratify heart failure patients for potential left ventricular assist device therapy? J Heart Lung Transplant. 2009;28(3):231-236.
- Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2017;70(6):776-803.
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200.
Loading PDF...