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The HFSS includes mean arterial blood pressure, heart rate at rest, left ventricular ejection fraction (LVEF), serum sodium, presence of intraventricular conduction delay (QRS-interval ��0.12?s), etiology of heart failure (ischemic versus dilated), and maximum oxygen uptake (VO2 max). A lower score indicates a higher mortality risk and patients can be grouped into risk scores based on cut-off values [5]. The GTSS was derived from data of all patients newly registered on the German HTx waiting-list 1997, and was validated in all new patients of the following year using death while waiting as outcome measure [6]. The model includes LVEF, cardiac index, patient location (home, ward, intensive care unit), http://www.selleck.cn/products/MK-1775.html use of catecholamines, mechanical circulatory support, and dialysis. A higher score indicates a worse health status [6]. Computational algorithms and risk categories for both scores are displayed in Table?1. Missing data in medical parameters ranged from 0.9% (blood pressure, heart rate) to 24.8% in VO2 max. Depression http://www.selleckchem.com/products/Adriamycin.html was assessed using the German version of the Hospital Anxiety and Depression Scale (HADS) [16]. This scale has been validated extensively [17]. As this study focuses on depression, anxiety was not considered in the analyses. Descriptive information about anxiety is provided elsewhere [10]. Depression is measured using seven items (e.g. ��I look forward with enjoyment to things��, ��I feel cheerful���C both reverse scored; ��I feel as if I am slowed down��). Responses http://www.selleckchem.com/PD-1-PD-L1.html range from 0 to 3 and are added (maximum score?=?21). Greater scores are indicative of depression. In addition, we dichotomized depression scores yielding the variable depression status (not depressed versus depressed), based on the cut-off score of 9 [16]. Internal consistency for depression was Cronbach��s ��?=?0.81 in the norm sample of 6200 patients (90% cardiology patients) [16] and ��?=?0.77 in our sample. Changes in waiting-list status with date of change during the 12?months of follow-up were provided by Eurotransplant. We defined events of interest as (i) death attributable to all causes, (ii) high-urgency HTx (HU-HTx; transplantation while in high-urgency status), (iii) elective HTx (transplantation while not in high-urgency status), (iv) delisting because of clinical improvement (HTx no longer indicated), and (v) delisting because of clinical deterioration (HTx no longer indicated). High urgency status is applied to patients in intensive care units who fulfill one of the following criteria: (i) Cardiac index