Question 1

Does SHFM apply to HFpEF patients?

Accepted Answer

The SHFM was derived primarily from HFrEF cohorts. While it has been tested in some HFpEF populations, its performance is less well established for preserved EF. The MAGGIC score or the H₂FPEF prognosis substudy may be more appropriate for HFpEF.

Question 2

Can I use SHFM for acute decompensated heart failure?

Accepted Answer

No — SHFM is designed for chronic, ambulatory heart failure. The model assumes a stable baseline. For in-hospital or acute prognosis, use the ADHERE or OPTIMIZE-HF models. Reassess with SHFM once the patient is stable on optimal therapy.

Question 3

Does adding a new treatment automatically improve the SHFM prediction?

Accepted Answer

Yes — the model adjusts survival upward when guideline-directed medications and devices are included. This is clinically realistic. However, the model assumes average treatment effects from clinical trials; individual responses may differ, and tolerability must guide therapy.