Prognostic assessment of patients with chronic heart failure (both HFrEF and HFpEF).
To guide clinical decision-making regarding advanced therapies, including referral for heart transplantation or Left Ventricular Assist Device (LVAD) evaluation.
To demonstrate the potential survival benefit of guideline-directed medical therapy (GDMT) to patients.
Section 2
Formula & Logic
Model Overview
The SHFM is a multivariable Cox proportional hazards model derived from several prospective randomized trials. It incorporates 24 variables to estimate the hazard ratio and absolute survival probability over 1, 2, and 5 years.
Key Predictors
01
Demographics: Age and Sex.
02
Functional Status: NYHA Class and Ischemic vs. Non-ischemic etiology.
03
Physiology: LVEF and Systolic BP.
04
Labs: Sodium, Hemoglobin, Percent Lymphocytes, and Uric Acid.
05
Meds: Doses of diuretics, and presence of ACEi/ARB, Beta-blockers, and Statins.
06
Devices: Implantation of ICD or CRT.
Section 3
Pearls/Pitfalls
The Vicious Cycle of Diuretics
The model notably high-weights the dose of loop diuretics. While diuretics are necessary for symptom management, high doses are often markers of advanced refractory disease and neurohormonal activation, contributing strongly to the predicted hazard.
Shared Decision Making
The SHFM is uniquely suited for patient counseling. By toggling "protective" entries like ACEi or BB, a clinician can show a patient the projected "years of life gained" by adherence to GDMT.
Section 4
Evidence Appraisal
Original Derivation
The Seattle Heart Failure Model: prediction of survival in heart failure.
Levy WC et al. • Circulation.. 2006;113(11):1424-33. Derived from 1,125 patients and validated in 5 additional cohorts totalling 9,942 patients.
Validation of the Seattle Heart Failure Model in a modern heart failure cohort.
Kochi AN et al. • ESC Heart Fail.. 2021;8(2):1201-1208. Confirmed continued accuracy in the era of modern GDMT.
