Heart failure survival score continues to predict clinical outcomes in patients with heart failure receiving beta-blockers.

BACKGROUND The Heart Failure Survival Score (HFSS) has been previously shown to effectively risk-stratify patients under evaluation for heart transplantation. However, this model was developed before broad use of beta blockade. We hypothesized that the prognostic tool would retain its ability to risk stratify patients treated with beta-blockers. METHODS We collected clinical data on 524 consecutive patients referred for heart transplantation from 1994 to 2001. Kaplan-Meier survival analysis and multivariable Cox regression analysis were performed with events defined as death, left ventricular assist device placement, or United Network of Organ Sharing 1 heart transplantation. RESULTS Kaplan-Meier analysis of the patient population revealed effective discrimination by the survival score both for beta-blocker treated and untreated patients (both p <0.0001). Two-year event-free survival was 94% +/- 2% and 84% +/- 4% for beta-blocker and no beta-blocker patients in the low-risk HFSS strata. Cox proportional hazard modeling showed that HFSS strata (medium risk: HR 2.65, 95% CI 1.75-4.02, p <0.001; high risk: HR 5.51, 95% CI 3.64-8.33, p <0.001) and beta-blocker treatment (HR 0.45, 95% CI 0.31-0.64, p <0.001) were significant predictors of event-free survival. Receiver operating curves (area under the curve) for HFSS strata used to predict 2-year events were similar for beta-blocker treated (0.78 +/- 0.04) and untreated (0.80 +/- 0.03) patients. CONCLUSIONS The HFSS provides effective risk stratification with or without beta-blocker therapy. Consideration of beta-blocker therapy with survival score strata improves outcome prediction in patients evaluated for heart transplantation.

[1]  J. Cohn,et al.  The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. U.S. Carvedilol Heart Failure Study Group. , 1996, The New England journal of medicine.

[2]  F. Waagstein,et al.  Improved exercise hemodynamic status in dilated cardiomyopathy after beta-adrenergic blockade treatment. , 1994, Journal of the American College of Cardiology.

[3]  J. Hanley,et al.  The meaning and use of the area under a receiver operating characteristic (ROC) curve. , 1982, Radiology.

[4]  T. Hedner,et al.  Exercise hemodynamics and myocardial metabolism during long-term beta-adrenergic blockade in severe heart failure. , 1991, Journal of the American College of Cardiology.

[5]  I. Clements,et al.  Effect of metoprolol on rest and exercise left ventricular systolic and diastolic function in idiopathic dilated cardiomyopathy. , 2001, American heart journal.

[6]  G. Ewald,et al.  The effect of beta-adrenergic blockers on the prognostic value of peak exercise oxygen uptake in patients with heart failure. , 2003, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[7]  D. Rubin,et al.  Reducing Bias in Observational Studies Using Subclassification on the Propensity Score , 1984 .

[8]  C. Lau,et al.  Improvement in exercise performance and hemodynamics by labetalol in patients with idiopathic dilated cardiomyopathy. , 1990, American heart journal.

[9]  CIBIS-II Investigators and Committees.  The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial , 1999, The Lancet.

[10]  G. Ewald,et al.  The effect of β-adrenergic blockers on the prognostic value of peak exercise oxygen uptake in patients with heart failure , 2003 .

[11]  D. DeMets,et al.  Effect of carvedilol on survival in severe chronic heart failure. , 2001, The New England journal of medicine.

[12]  B. Whipp,et al.  A new method for detecting anaerobic threshold by gas exchange. , 1986, Journal of applied physiology.

[13]  Fach,et al.  Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF) , 1999, The Lancet.

[14]  J. Schwartz,et al.  Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. , 1996, Circulation.

[15]  E. Antman,et al.  ACC/AHA PRACTICE GUIDELINES ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary , 2002 .

[16]  G. MacGowan,et al.  Impact of beta-blocker therapy on functional capacity criteria for heart transplant listing. , 2003, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.