Seattle Heart Failure Model (SHFM)
Multivariable model for predicting 1-year and mean survival in patients with heart failure. Validated in over 9,000 patients across multiple trials. Estimates absolute and relative benefit of HF interventions.
Score interpretation
Estimated 1-year mortality < 5% based on current profile
→ Optimise GDMT (guideline-directed medical therapy): ACEi/ARB (or ARNI: sacubitril-valsartan if EF <= 40%), beta-blocker (carvedilol, bisoprolol, or metoprolol succinate), MRA (spironolactone/eplerenone if EF <= 40%), SGLT2 inhibitor (dapagliflozin or empagliflozin -- all HF regardless of EF per 2023 ESC/NICE); 6-monthly cardiology review; BNP/NT-proBNP monitoring; echocardiography annually or after treatment change; ICD if EF <= 35% and NYHA II-III on GDMT for >= 3 months (unless reversible cause or LBBB warranting CRT assessment).
Estimated 1-year mortality 5-10% -- treatment optimisation required
→ Review and maximise GDMT: ensure ARNI (sacubitril-valsartan) if HFrEF and tolerated; up-titrate ACEi/ARB/ARNI to target dose; up-titrate beta-blocker to target heart rate < 70 bpm; add diuretic (furosemide) for fluid overload; SGLT2 inhibitor if not already prescribed; consider ICD if EF <= 35%; refer heart failure specialist; cardiac rehabilitation referral; BNP-guided therapy; TAVI/revascularisation assessment if structural cause; sodium restriction (< 2 g/day); fluid restriction (1.5 L/day) if hyponatraemia; daily weight monitoring.
Estimated 1-year mortality > 10% -- advanced heart failure pathway
→ Advanced heart failure specialist referral; evaluate for: CRT (QRS >= 130 ms LBBB morphology, EF <= 35%, NYHA II-III); LVAD assessment (INTERMACS profile 2-4); cardiac transplant assessment if age < 70 years and no contraindications; palliative care referral; advance care planning (DNACPR, CPR preferences, hospitalisation thresholds); consider TAVI/MitraClip for valve pathology; wearable defibrillator; BNP/NT-proBNP every 1-3 months; diuretic optimisation (IV furosemide if needed); consider iron infusion if ferritin < 100 or 100-299 with transferrin saturation < 20%; end-of-life preferences documented.
Interpretation bands for the Seattle HF Model. Apply clinical judgement and local guidance.
References
- Levy WC et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation. 2006;113(11):1424-1433.
- McDonagh TA et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-3726.
Related
Curated clinical cross-links plus same-class fallbacks.
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.