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Women are more likely to die from heart failure (HF) than men, but are less likely to receive heart transplant (HT) or left ventricular assist device (LVAD). We sought to investigate differences in HT/LVAD eligibility based on sex. We identified all patients evaluated at Emory University for HT/

Category: 24. Myocardial Function/Heart Failure—Clinical Nonpharmacological TreatmentSession-Poster Board Number: 1160-25Authors: Catherine Norton, Vasiliki Georgiopoulou, Andreas Kalogeropoulos, Lucy Fike, Grigorios Giamouzis, Sonjoy Laskar, Robert Cole, Andrew Smith, Wilson W.H. Tang, Sandra Dunbar, Javed Butler, Emory University School of Medicine, Atlanta, GA, Cleveland Clinic Foundation, Cleveland, OH Background: Cumulative adherence with self-care recommendations and association with outcomes is not well described in heart failure (HF) patients.Methods: We used self-report to evaluate adherence to eight HF self-care recommendations (exercise, medications, alcohol and smoking habits, diet, weight and symptom monitoring) among 286 patients with HF (age, 56±11.6 years; 34.3% female; 46.2% black). Adherence was defined as optimal (overall ≥80%) or ideal (≥80% adherence to each recommendation). Outcomes included death or transplant or ventricular assist device placement; rates of emergency department visits, hospitalizations, and length of stay; health status using the Kansas City Cardiomyopathy Questionnaire.Results: Mean follow-up was 525±295 days. Adherence to individual recommendations ranged from 89% for medication to 26% for exercise. Optimal adherence was reported by 34% of patients whereas only 11% indicated ideal adherence. Education was the only sociodemographic variable associated with adherence (odds ratio [OR] 1.15; 95% confidence interval [CI] 1.05-1.25 for optimal; and OR 1.15; 95% CI 1.02-1.30 for ideal adherence per year of education). Patients with optimal or ideal adherence had better clinical outcomes (Table); however, only ideal adherence was associated with better quality of life.Conclusions: In this HF cohort, better adherence with self-care recommendations was associated with improved clinical outcomes. However, adherence was suboptimal for most patients. Optimal AdherenceDeath/Left Ventricular Assist Device/Transplant, % 8.0 9.2 0.73All cause hospitalizations, per 1000 patient-days 2.8 2.0 0.07HF hospitalizations, per 1000 patient-days 1.2 0.9 0.12Emergency department visits, per 1000 patient-days 1.3 0.8 0.02Hospital length of stay, per 1000 patient-days 13.8 8.8 0.06Hospital length of stay - HF only, per 1000 patient-days 8.5 5.5 0.13Kansas City Cardiomyopathy Questionnaire Overall Summary Score 65.2±23.2 67.9±24.3 0.37Ideal AdherenceDeath/Left Ventricular Assist Device/Transplant, % 8.3 9.4 0.83All cause hospitalizations, per 1000 patient-days 2.7 1.5 0.09HF hospitalizations, per 1000 patient-days 1.2 0.4 0.08Emergency department visits, per 1000 patient-days 1.2 0.8 0.33Hospital length of stay, per 1000 patient-days 13.6 3.0 0.02Hospital length of stay - HF only, per 1000 patient-days 8.3 0.8 0.04Kansas City Cardiomyopathy Questionnaire Overall Summary Score 65.1±23.5 74.3±23.5 0.04

Objectives The aim of this study was to validate the Seattle Heart Failure Model (SHFM) in patients with advanced heart failure (HF). Background The SHFM was developed primarily from clinical trial databases and extrapolated the benefit of interventions from published data. Methods We evaluated the discrimination and calibration of SHFM in 445 advanced HF patients (age 52 ± 12 years, 68.5% male, 52.4% white, ejection fraction 18 ± 8%) referred for cardiac transplantation. The primary end point was death (n = 92), urgent transplantation (n = 14), or left ventricular assist device (LVAD) implantation (n = 3); a secondary analysis was performed on mortality alone. Results Patients were receiving optimal therapy (angiotensin-II modulation 92.8%, beta-blockers 91.5%, aldosterone antagonists 46.3%), and 71.0% had an implantable device (defibrillator 30.4%, biventricular pacemaker 3.4%, combined 37.3%). During a median follow-up of 21 months, 109 patients (24.5%) had an event. Although discrimination was adequate (c-statistic >0.7), the SHFM overall underestimated absolute risk (observed vs. predicted event rate: 11.0% vs. 9.2%, 21.0% vs. 16.6%, and 27.9% vs. 22.8% at 1, 2, and 3 years, respectively). Risk underprediction was more prominent in patients with an implantable device. The SHFM had different calibration properties in white versus black patients, leading to net underestimation of absolute risk in blacks. Race-specific recalibration improved the accuracy of predictions. When analysis was restricted to mortality, the SHFM exhibited better performance. Conclusions In patients with advanced HF, the SHFM offers adequate discrimination, but absolute risk is underestimated, especially in blacks and in patients with devices. This is more prominent when including transplantation and LVAD implantation as an end point.