High early event rates in patients with questionable eligibility for advanced heart failure therapies: Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry

Amrut V. Ambardekar, Rhondalyn C. Forde-McLean, Michelle M. Kittleson, Garrick C. Stewart, Maryse Palardy, Jennifer T. Thibodeau, Adam D. DeVore, Maria M. Mountis, Linda Cadaret, Jeffrey J. Teuteberg, Salpy V. Pamboukian, Ryan S. Cantor, JoAnn Lindenfeld

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Heart and Lung Transplantation
DOIs
StateAccepted/In press - 2016

Fingerprint

Heart-Assist Devices
Registries
Arm
Heart Failure
Transplants
Therapeutics
Mortality
Anemia
Decision Making
Transplantation

Keywords

  • Cardiac transplantation
  • Destination therapy
  • Mechanical support
  • Patient selection
  • Ventricular assist device

ASJC Scopus subject areas

  • Transplantation
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

High early event rates in patients with questionable eligibility for advanced heart failure therapies : Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry. / Ambardekar, Amrut V.; Forde-McLean, Rhondalyn C.; Kittleson, Michelle M.; Stewart, Garrick C.; Palardy, Maryse; Thibodeau, Jennifer T.; DeVore, Adam D.; Mountis, Maria M.; Cadaret, Linda; Teuteberg, Jeffrey J.; Pamboukian, Salpy V.; Cantor, Ryan S.; Lindenfeld, JoAnn.

In: Journal of Heart and Lung Transplantation, 2016.

Research output: Contribution to journalArticle

Ambardekar, Amrut V. ; Forde-McLean, Rhondalyn C. ; Kittleson, Michelle M. ; Stewart, Garrick C. ; Palardy, Maryse ; Thibodeau, Jennifer T. ; DeVore, Adam D. ; Mountis, Maria M. ; Cadaret, Linda ; Teuteberg, Jeffrey J. ; Pamboukian, Salpy V. ; Cantor, Ryan S. ; Lindenfeld, JoAnn. / High early event rates in patients with questionable eligibility for advanced heart failure therapies : Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry. In: Journal of Heart and Lung Transplantation. 2016.
@article{0045c36ae22c4c11ab55c8cd452a5473,
title = "High early event rates in patients with questionable eligibility for advanced heart failure therapies: Results from the Medical Arm of Mechanically Assisted Circulatory Support (Medamacs) Registry",
abstract = "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.",
keywords = "Cardiac transplantation, Destination therapy, Mechanical support, Patient selection, Ventricular assist device",
author = "Ambardekar, {Amrut V.} and Forde-McLean, {Rhondalyn C.} and Kittleson, {Michelle M.} and Stewart, {Garrick C.} and Maryse Palardy and Thibodeau, {Jennifer T.} and DeVore, {Adam D.} and Mountis, {Maria M.} and Linda Cadaret and Teuteberg, {Jeffrey J.} and Pamboukian, {Salpy V.} and Cantor, {Ryan S.} and JoAnn Lindenfeld",
year = "2016",
doi = "10.1016/j.healun.2016.01.014",
language = "English (US)",
journal = "Journal of Heart and Lung Transplantation",
issn = "1053-2498",
publisher = "Elsevier USA",

}

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

PY - 2016

Y1 - 2016

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

JO - Journal of Heart and Lung Transplantation

JF - Journal of Heart and Lung Transplantation

SN - 1053-2498

ER -