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.