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

18 Scopus citations

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)
Pages (from-to)722-730
Number of pages9
JournalJournal of Heart and Lung Transplantation
Volume35
Issue number6
DOIs
StatePublished - Jun 1 2016

    Fingerprint

Keywords

  • cardiac transplantation
  • destination therapy
  • mechanical support
  • patient selection
  • ventricular assist device

ASJC Scopus subject areas

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

Cite this

Ambardekar, A. V., Forde-McLean, R. C., Kittleson, M. M., Stewart, G. C., Palardy, M., Thibodeau, J. T., DeVore, A. D., Mountis, M. M., Cadaret, L., Teuteberg, J. J., Pamboukian, S. V., Cantor, R. S., & Lindenfeld, J. (2016). 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. Journal of Heart and Lung Transplantation, 35(6), 722-730. https://doi.org/10.1016/j.healun.2016.01.014