TY - JOUR
T1 - High early event rates in patients with questionable eligibility for advanced heart failure therapies
T2 - Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry
AU - Ambardekar, Amrut V.
AU - Forde-McLean, Rhondalyn C.
AU - Kittleson, Michelle M.
AU - Stewart, Garrick C.
AU - Palardy, Maryse
AU - Thibodeau, Jennifer T.
AU - DeVore, Adam D.
AU - Mountis, Maria M.
AU - Cadaret, Linda
AU - Teuteberg, Jeffrey J.
AU - Pamboukian, Salpy V.
AU - Cantor, Ryan S.
AU - Lindenfeld, JoAnn
N1 - Funding Information:
A.D.D. reports receiving research support from the American Heart Association, Amgen, Maquet, Novartis, and Thoratec Corporation and consulting fees from Maquet. J.J.T. reports receiving advertising board and speaking honoraria from HeartWare, Abiomed, and CareDx and support from Thoratec and Sunshine Heart. R.S.C. reports receiving support from Sunshine Heart. The remaining authors have no disclosures.
Funding Information:
This project has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN268201100025C. A.V.A. is supported by a Scientist Development Grant from the American Heart Association and by the Boettcher Foundation Webb-Waring Biomedical Research Program.
Publisher Copyright:
© 2016 International Society for Heart and Lung Transplantation. All rights reserved.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background The prognosis of ambulatory patients with advanced heart failure (HF) who are not yet inotrope dependent and implications for evaluation and timing for transplant or destination therapy with a left ventricular assist device (DT-LVAD) are unknown. We hypothesized that the characteristics defining eligibility for advanced HF therapies would be a primary determinant of outcomes in these patients. Methods Ambulatory patients with advanced HF (New York Heart Association class III-IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4-7) were enrolled across 11 centers from May 2013 to February 2015. Patients were stratified into 3 groups: likely transplant eligible, DT-LVAD eligible, and ineligible for both transplant and DT-LVAD. Clinical characteristics were collected, and patients were prospectively followed for death, transplant, and left ventricular assist device implantation. Results The study enrolled 144 patients with a mean follow-up of 10 ± 6 months. Patients in the ineligible cohort (n = 43) had worse congestion, renal function, and anemia compared with transplant (n = 51) and DT-LVAD (n = 50) eligible patients. Ineligible patients had higher mortality (23.3% vs 8.0% in DT-LVAD group and 5.9% in transplant group, p = 0.02). The differences in mortality were related to lower rates of transplantation (11.8% in transplant group vs 2.0% in DT-LVAD group and 0% in ineligible group, p = 0.02) and left ventricular assist device implantation (15.7% in transplant group vs 2.0% in DT-LVAD group and 0% in ineligible group, p < 0.01). Conclusions Ambulatory patients with advanced HF who were deemed ineligible for transplant and DT-LVAD had markers of greater HF severity and a higher rate of mortality compared with patients eligible for transplant or DT-LVAD. The high early event rate in this group emphasizes the need for timely evaluation and decision making regarding lifesaving therapies.
AB - Background The prognosis of ambulatory patients with advanced heart failure (HF) who are not yet inotrope dependent and implications for evaluation and timing for transplant or destination therapy with a left ventricular assist device (DT-LVAD) are unknown. We hypothesized that the characteristics defining eligibility for advanced HF therapies would be a primary determinant of outcomes in these patients. Methods Ambulatory patients with advanced HF (New York Heart Association class III-IV, Interagency Registry for Mechanically Assisted Circulatory Support profiles 4-7) were enrolled across 11 centers from May 2013 to February 2015. Patients were stratified into 3 groups: likely transplant eligible, DT-LVAD eligible, and ineligible for both transplant and DT-LVAD. Clinical characteristics were collected, and patients were prospectively followed for death, transplant, and left ventricular assist device implantation. Results The study enrolled 144 patients with a mean follow-up of 10 ± 6 months. Patients in the ineligible cohort (n = 43) had worse congestion, renal function, and anemia compared with transplant (n = 51) and DT-LVAD (n = 50) eligible patients. Ineligible patients had higher mortality (23.3% vs 8.0% in DT-LVAD group and 5.9% in transplant group, p = 0.02). The differences in mortality were related to lower rates of transplantation (11.8% in transplant group vs 2.0% in DT-LVAD group and 0% in ineligible group, p = 0.02) and left ventricular assist device implantation (15.7% in transplant group vs 2.0% in DT-LVAD group and 0% in ineligible group, p < 0.01). Conclusions Ambulatory patients with advanced HF who were deemed ineligible for transplant and DT-LVAD had markers of greater HF severity and a higher rate of mortality compared with patients eligible for transplant or DT-LVAD. The high early event rate in this group emphasizes the need for timely evaluation and decision making regarding lifesaving therapies.
KW - cardiac transplantation
KW - destination therapy
KW - mechanical support
KW - patient selection
KW - ventricular assist device
UR - http://www.scopus.com/inward/record.url?scp=84960532510&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84960532510&partnerID=8YFLogxK
U2 - 10.1016/j.healun.2016.01.014
DO - 10.1016/j.healun.2016.01.014
M3 - Article
C2 - 26987599
AN - SCOPUS:84960532510
SN - 1053-2498
VL - 35
SP - 722
EP - 730
JO - Journal of Heart and Lung Transplantation
JF - Journal of Heart and Lung Transplantation
IS - 6
ER -