Accuracy of Seattle Heart Failure Model and HeartMate II Risk Score in Non–Inotrope-Dependent Advanced Heart Failure Patients

The use of continuous-flow left ventricular assist devices (LVADs) as therapy for patients with end-stage heart failure (HF) is growing rapidly, and overall outcomes are improving. This has prompted consideration of LVAD implantation slightly earlier in the clinical course of HF, in patients who have evidence of advanced disease but have not yet had obvious hemodynamic decompensation requiring inotropic therapy, in the hopes of reducing perioperative risks and improving overall outcomes. However, in these patients, making an informed clinical choice between LVAD and medical therapy can be challenging for patients and providers. The risk of HF progression may not be obvious, whereas the risks/benefits of LVAD therapy have not been well established because they represented only a small minority of subjects in pivotal LVAD trials.