ACC: Heart failure model could predict outcomes for patients, shorten inpatient stays

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ATLANTA - In utilizing the Seattle Heart Failure Model (SHFM), overall survival scores for patients admitted with acutely decompensated heart failure (ADHF) may be improved, according to Samira Bahrainy, MD, department of cardiology at the University of Washington, Harborview Medical Center, and colleagues during the poster presentations held on March 15 at the 59th annual American College of Cardiology (ACC) conference.

Her study explained that a patient’s long-term survival rate and average length of hospital stay may be reduced by the utilization of an idealized Seattle Heart Failure score, as the absence of defined goals of therapy in patients admitted with ADHF has been associated with significant short- and long-term morbidity and mortality.

Bahrainy and colleagues said, “The SHFM is a multivariate risk model that predicts one-, two-, and three-year survival in chronic stable heart failure patients using characteristics related to clinical status, therapy and laboratory parameters, and accurately predicts survival in outpatients with heart failure.”

For the retrospective study, the researchers obtained data from 202 consecutive patients admitted with a primary diagnosis of ADHF and tested whether inpatient optimization of the SHFM could offer therapeutic goals to enhance survival within this patient population.

“In the past, and in other models, we could predict survival scores based on variables in admission and discharge for patients with ADHF by the SHFM because it has been validated for patients in an outpatient setting,” said Bahrainy, who noted that it was the first time the SHFM was used in an inpatient setting.

The researchers found that as the clinical profiles of the patients were optimized, the average length of hospital stay decreased simultaneously. The life expectancies of 6, 6.7, 8.9 and 9.6 years reported length of average hospital stay to be 10.9, 9, 7.4 and 6.1 days, respectively, they wrote.

In addition, post-SHFM optimization was found to be associated with an increase of one-, two- and five-year survival rates and the authors noted that no significant differences were found between gender, age or etiology of heart failure.

However, certain medications were found to be associated with enhanced long-term survival and decreased length of stay, including reduction in the use of metolazone, at the expense of increased loop diuretic usage and increased beta blocker and mineralocorticoid inhibitor usage, said the researchers.

These data suggest that for patients admitted with ADHF, novel optimization of a patient’s clinical profile by utilization of an idealized Seattle Heart Failure score may result in improved long-term survival and reduction in mean length of stay.

In using the SHFM for the inpatient population, Bahrainy said that the research yielded both interesting and unanticipated results, including the relationship between length of stay and mean life expectancy.

“That was the most surprising, most reliable result,” she noted.

“If we optimized the patients based on this scoring system, we could decrease the length of stay for sure,” she concluded. " We can also look into other variables based on this scoring system in order to discharge a sick patient, ideally, hoping for a better survival score.”