Amrut V Ambardekar1, Rhondalyn C Forde-McLean2, Michelle M Kittleson3, Garrick C Stewart4, Maryse Palardy5, Jennifer T Thibodeau6, Adam D DeVore7, Maria M Mountis8, Linda Cadaret9, Jeffrey J Teuteberg10, Salpy V Pamboukian11, Ryan S Cantor12, JoAnn Lindenfeld13. 1. Division of Cardiology, University of Colorado, Aurora, Colorado. Electronic address: Amrut.Ambardekar@ucdenver.edu. 2. Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 3. Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. 4. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 5. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan. 6. Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas. 7. Division of Cardiology, Duke University Medical School, Durham, North Carolina. 8. Division of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. 9. Division of Cardiology, University of Iowa, Iowa City, Iowa. 10. Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 11. Division of Cardiovascular Diseases, Birmingham, Alabama. 12. Division of Cardiothoracic Surgery, and Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 13. Vanderbilt Heart and Vascular Institute, Nashville, Tennessee.
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.
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.
Authors: James K Kirklin; David C Naftel; Francis D Pagani; Robert L Kormos; Lynne W Stevenson; Elizabeth D Blume; Marissa A Miller; J T Baldwin; J Timothy Baldwin; James B Young Journal: J Heart Lung Transplant Date: 2014-04-21 Impact factor: 10.247
Authors: Jerry D Estep; Randall C Starling; Douglas A Horstmanshof; Carmelo A Milano; Craig H Selzman; Keyur B Shah; Matthias Loebe; Nader Moazami; James W Long; Josef Stehlik; Vigneshwar Kasirajan; Donald C Haas; John B O'Connell; Andrew J Boyle; David J Farrar; Joseph G Rogers Journal: J Am Coll Cardiol Date: 2015-10-20 Impact factor: 24.094
Authors: Jonathan Afilalo; Salvatore Mottillo; Mark J Eisenberg; Karen P Alexander; Nicolas Noiseux; Louis P Perrault; Jean-Francois Morin; Yves Langlois; Samuel M Ohayon; Johanne Monette; Jean-Francois Boivin; David M Shahian; Howard Bergman Journal: Circ Cardiovasc Qual Outcomes Date: 2012-03-06
Authors: L P Fried; C M Tangen; J Walston; A B Newman; C Hirsch; J Gottdiener; T Seeman; R Tracy; W J Kop; G Burke; M A McBurnie Journal: J Gerontol A Biol Sci Med Sci Date: 2001-03 Impact factor: 6.053
Authors: Shannon M Dunlay; Soon J Park; Lyle D Joyce; Richard C Daly; John M Stulak; Sheila M McNallan; Véronique L Roger; Sudhir S Kushwaha Journal: J Heart Lung Transplant Date: 2013-12-27 Impact factor: 10.247
Authors: Kathleen L Grady; David C Naftel; Susan Myers; Mary Amanda Dew; Gerdi Weidner; John A Spertus; Katharine Idrissi; Hochang B Lee; Edwin C McGee; James K Kirklin Journal: J Heart Lung Transplant Date: 2014-10-31 Impact factor: 10.247
Authors: 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 Journal: J Heart Lung Transplant Date: 2018-10-01 Impact factor: 10.247
Authors: Amrut V Ambardekar; Jennifer T Thibodeau; Adam D DeVore; Michelle M Kittleson; Rhondalyn C Forde-McLean; Maryse Palardy; Maria M Mountis; Linda Cadaret; Jeffrey J Teuteberg; Salpy V Pamboukian; Rongbing Xie; Lynne W Stevenson; Garrick C Stewart Journal: JACC Heart Fail Date: 2017-08-16 Impact factor: 12.035
Authors: Michelle M Kittleson; Amrut V Ambardekar; Lynne W Stevenson; Nisha A Gilotra; Palak Shah; Gregory A Ewald; Jennifer T Thibodeau; Josef Stehlik; Maryse Palardy; Jerry D Estep; Thomas M Cascino; J Timothy Baldwin; Neal Jeffries; Shokoufeh Khalatbari; Matheos Yosef; Wendy Taddei Peters; Blair Richards; Douglas L Mann; Keith D Aaronson; Garrick C Stewart Journal: J Heart Lung Transplant Date: 2021-09-16 Impact factor: 10.247
Authors: Andrea Alcaraz; Andres Pichon-Riviere; Carlos Rojas-Roque; Juan Martín González; Daniela Prina; Germán Solioz; Federico Augustovski; Alfredo Palacios Journal: PLoS One Date: 2022-08-01 Impact factor: 3.752
Authors: Larry A Allen; Colleen K McIlvennan; Jocelyn S Thompson; Shannon M Dunlay; Shane J LaRue; Eldrin F Lewis; Chetan B Patel; Laura Blue; Diane L Fairclough; Erin C Leister; Russell E Glasgow; Joseph C Cleveland; Clifford Phillips; Vicie Baldridge; Mary Norine Walsh; Daniel D Matlock Journal: JAMA Intern Med Date: 2018-04-01 Impact factor: 21.873