Predicts survival in heart failure.
Why Use
Provides a validated survival estimate at 1, 2, and 5 years for systolic heart failure, aiding in prognostication (note: this tool currently only supports 1- and 5-year estimates). Unlike similar models, it was derived in a broad heart failure population and incorporates a wide range of clinical and treatment variables.
When to Use
Use in patients with chronic heart failure (predominantly systolic dysfunction) to estimate survival.
Formula
The Seattle Heart Failure Score is calculated by the following: Seattle HF Score = (age/10)*ln(1.09) + male*ln(1.089) + (NYHA class)*ln(1.6) + (100/(ejection fraction))*ln(1.03) + (if ischemic etiology)*ln(1.354) + (SBP/10)*ln(0.877) + (diuretic dose)*ln(1.178) + (if using allopurinol)*ln(1.571) + (if using statins)*ln(0.63) + (if using ACE inhibitors) + (if using beta-blockers)*ln(0.66) + (if using angiotensin receptor blockers)*ln(0.85) + (if using K-sparing diuretics)*ln(0.74) + (if using biventricular pacemaker) + (if using implantable cardioverter-defibrillator)*ln(0.73) + (if using biventricular implantable cardioverter-defibrillator)*ln(0.79) + (138 – sodium)*ln(1.05) + (100/(total cholesterol, mg/dL))*ln(2.206) + (hgb score) + ((% lymphocytes)/5)*ln(0.897) + (uric acid, mg/dL)*ln(1.064), where diuretic dose, mg/kg = (furosemide + 2*torsemide + 26.7*b umetanide + 40*metolazone + 3.2*hydrochlorothiazide)/(weight, kg) This translates to the following equivalent doses used for this calculator (based on 80 mg of furosemide): Torsemide: 40 mg. Bumetanide: 3 mg. Metolazone: 2 mg. Hydrochlorothiazide: 25 mg. If hemoglobin, g/dL <16 g/dL, hgb score = (16 – hemoglobin)*ln(1.124) If hemoglobin, g/dL ≥16 g/dL, hgb score = (hemoglobin – 16)*ln(1.336) Note: Lymphocyte values >47% are set to 47%. Uric acid values <3.4 mg/dL are set to 3.4 mg/dL. SBP values >160 mm Hg are set to 160 mm Hg. Sodium values >138 mEq/L are set to 138 mEq/L.
Pearls / Pitfalls
External validity varies across different populations; see the Evidence section for links to additional research studies. Does not guide therapy or provide specific medication recommendations; it merely predicts possible benefits from certain interventions. Predictions may be unreliable in patients with diastolic heart failure.
Management
This tool does not explicitly provide treatment recommendations. Management should be based on a combination of guidelines, best practices, specialist expertise, and patient preferences.
Advice
Use results to guide discussions with patients about prognosis, which may inform decisions on medications, devices, transplantation, and end-of-life care. Inputs can be adjusted to estimate the potential impact of additional interventions (e.g., medications, devices) on mortality risk.