Validity of the Seattle Heart Failure Model after heart failure hospitalization

AIMS: Heart failure hospitalization is a sentinel event associated with increased mortality risk. Whether long-term heart failure risk models such as the Seattle Heart Failure Model (SHFM) accurately assess risk in the post-hospital setting is unknown. METHODS AND RESULTS: The SHFM was applied to a cohort of 2242 consecutive patients (50% women; mean age 73) on discharge after acute heart failure hospitalization and analysed for the primary endpoint of all-cause mortality. Model discrimination and calibration were assessed. Direct patient-level comparison between our study cohort and the original SHFM cohorts was also performed to confirm and quantify the degree and extent of increased mortality risk attributable to post-hospital status. The SHFM demonstrated good overall risk discrimination (area under the receiver operating characteristic curve 0.704) and was well calibrated in patients <65 years old. The SHFM significantly underestimated mortality risk in patients ≥65 years old post-hospitalization. Direct patient-level comparison revealed a stepwise increase in adjusted mortality risk attributable to post-hospital status for each advancing age group ≥65 years old. This heightened mortality risk showed a diminishing trend over 18 months after discharge. CONCLUSIONS: The SHFM accurately predicts mortality risk in younger patients after acute heart failure hospitalization. However, patients ≥65 years old had increased adjusted mortality risk for up to 18 months after discharge compared with ambulatory heart failure patients, a pattern consistent with the well-described post-hospital syndrome.