Outcomes with ambulatory advanced heart failure from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry

Amrut V. Ambardekar; Michelle M. Kittleson; Maryse Palardy; Maria M. Mountis; Rhondalyn C. Forde-McLean; Adam D. DeVore; Salpy V. Pamboukian; Jennifer T. Thibodeau; Jeffrey J. Teuteberg; Linda Cadaret; Rongbing Xie; Wendy Taddei-Peters; David C. Naftel; James K. Kirklin; Lynne W. Stevenson; Garrick C. Stewart

doi:10.1016/j.healun.2018.09.021

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Outcomes with ambulatory advanced heart failure from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry

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Outcomes with ambulatory advanced heart failure from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry

Amrut V. Ambardekar, Michelle M. Kittleson, Maryse Palardy, Maria M. Mountis, Rhondalyn C. Forde-McLean, Adam D. DeVore, Salpy V. Pamboukian, Jennifer T. Thibodeau, Jeffrey J. Teuteberg, Linda Cadaret, …

The Journal of heart and lung transplantation, Vol.38(4), pp.408-417

04/2019

DOI: 10.1016/j.healun.2018.09.021

PMCID: PMC6452871

PMID: 30948210

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Abstract

The outlook for ambulatory patients with advanced heart failure (HF) and the appropriate timing for left ventricular assist device (LVAD) or transplant remain uncertain. The aim of this study was to better understand disease trajectory and rates of progression to subsequent LVAD therapy and transplant in ambulatory advanced HF. Unlabelled boxPatients with advanced HF who were New York Heart Association (NYHA) Class III or IV and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Profiles 4 to 7, despite optimal medical therapy (without inotropic therapy), were enrolled across 11 centers and followed for the end-points of survival, transplantation, LVAD placement, and health-related quality of life. A secondary intention-to-treat survival analysis compared outcomes for MedaMACS patients with a matched group of Profile 4 to 7 patients with LVADs from the INTERMACS registry. Between May 2013 and October 2015, 161 patients were enrolled with INTERMACS Profiles 4 (12%), 5 (32%), 6 (49%), and 7 (7%). By 2 years after enrollment, 75 (47%) patients had reached a primary end-point with 39 (24%) deaths, 17 (11%) undergoing LVAD implantation, and 19 (12%) receiving a transplant. Compared with 1,753 patients with Profiles 4 to 7 receiving LVAD therapy, there was no overall difference in intention-to-treat survival between medical and LVAD therapy, but survival with LVAD therapy was superior to medical therapy among Profile 4 and 5 patients (p = 0.0092). Baseline health-related quality of life was lower among patients receiving a LVAD than those enrolled on continuing oral medical therapy, but increased after 1 year for survivors in both cohorts. Ambulatory patients with advanced HF are at high risk for poor outcomes, with only 53% alive on medical therapy after 2 years of follow-up. Survival was similar for medical and LVAD therapy in the overall cohort, which included the lower severity Profiles 6 and 7, but survival was better with LVAD therapy among patients in Profiles 4 and 5. Given the poor outcomes in this group of advanced HF patients, timely consideration of transplant and LVAD is of critical importance.

advanced heart failure

cardiac transplantation

mechanical circulatory support

patient decision-making

ventricular assist device

Details

Title: Subtitle: Outcomes with ambulatory advanced heart failure from the Medical Arm of Mechanically Assisted Circulatory Support (MedaMACS) Registry
Creators: Amrut V. Ambardekar - University of Colorado Denver
Michelle M. Kittleson - Cedars-Sinai Smidt Heart Institute
Maryse Palardy - University of Michigan
Maria M. Mountis - Cleveland Clinic
Rhondalyn C. Forde-McLean - University of Pennsylvania
Adam D. DeVore - Duke University
Salpy V. Pamboukian - University of Alabama at Birmingham
Jennifer T. Thibodeau - The University of Texas Southwestern Medical Center
Jeffrey J. Teuteberg - Stanford University
Linda Cadaret - University of Iowa
Rongbing Xie - University of Alabama at Birmingham
Wendy Taddei-Peters - National Heart Lung and Blood Institute
David C. Naftel - University of Iowa
James K. Kirklin - University of Iowa
Lynne W. Stevenson - Vanderbilt University
Garrick C. Stewart - Brigham and Women's Hospital
Resource Type: Journal article
Publication Details: The Journal of heart and lung transplantation, Vol.38(4), pp.408-417
DOI: 10.1016/j.healun.2018.09.021
PMID: 30948210
PMCID: PMC6452871
NLM abbreviation: J Heart Lung Transplant
ISSN: 1053-2498
eISSN: 1557-3117
Publisher: Elsevier Inc
Grant note: name: the National Heart, Lung, award: HHSN268201100025C; name: Blood Institute; DOI: 10.13039/100000002, name: National Institutes of Health; name: Department of Health and Human Services; name: the Board of Trustees of the University of Alabama for the University of Alabama at Birmingham; DOI: 10.13039/100000968, name: the American Heart Association; name: the Boettcher Foundation's Webb-Waring Biomedical Research Program; name: the STS INTERMACS registry; DOI: 10.13039/100000050, name: NHLBI, award: HHSN268201100025C
Language: English
Date published: 04/2019
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984359931902771

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