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Wednesday, March 22, 2006

Heart Failure Model Accurately Predicts Patient Survival

The first computer-based model to translate medications and devices that a
heart failure patient receives into predicted years of survival has been
developed at the University of Washington, Seattle. The model was described
here at the 55th annual scientific session of the American College of
Cardiology, and a report on the model is published in the March 21 issue of

The Seattle Heart Failure Model was developed by Wayne C. Levy, MD,
associate professor of medicine in the Division of Cardiology, and
colleagues at the University of Washington. He described the Web-based
program for attendees at the meeting.

Medications prescribed and devices used by a patient with heart failure are
plugged into the model, along with simple clinical and laboratory findings.
Dr. Levy said the Seattle Heart Failure Model accurately predicts 1-, 2- and
3-year survival rates.

The Seattle team used a total of 6 databases, involving 9942 patients with
heart failure, to develop the Web-based or Palm Pilot-based program. The
physician enters the type of medications the patient is on, whether the
patient has received an implantable cardioverter defibrillator (ICD), as
well as the results of a number of simple clinical findings and widely
available laboratory test results.

The program "allows easy and rapid calculation of the projected mortality at
baseline and after interventions for patients with congestive heart
failure," the investigators reported.

"It determines if you are on appropriate medications or devices," Dr. Levy
told Medscape. "For example, you can calculate the benefit of adding an
angiotensin-converting enzyme (ACE) inhibitor to beta-blocker therapy, or
adding an angiotensin receptor-blocker to beta-blockers and ACE inhibitors."

Dr. Levy added, "It changes survival figures from percentages to the number
of years lived longer. This makes it easier for patients and physicians to

Dr. Levy said the model might be able to be used to assess risk of death,
and to determine if risk increases exponentially toward the end of life. The
model may also be useful in predicting the number of hospitalizations and
number of days in the hospital per year.

"We didn't look specifically at quality of life with the model, but almost
everything that improves survival, with the exception of the ICD, improves
quality of life," the Seattle cardiologist said.

"We're determining if the model can be used as the control group in future
studies of heart failure treatments, replacing the placebo group," Dr. Levy
added. The model can be accessed at

Gerald Fletcher, MD, from the Division of Cardiology at the Mayo Clinic in
Jacksonville, Florida, commented in an interview with Medscape that "there
are 4 or 5 drugs that really affect heart failure survival.... However, what
is not included in this model is exercise. We really believe that regular
exercise will make a difference [in heart failure survival].... This is an
intervention that has no cost."


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