Garrick C Stewart1, Michelle M Kittleson2, Parag C Patel2, Jennifer A Cowger2, Chetan B Patel2, Maria M Mountis2, Frances L Johnson2, Maya E Guglin2, J Eduardo Rame2, Jeffrey J Teuteberg2, Lynne W Stevenson2. 1. From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.). gcstewart@partners.org. 2. From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Abstract
BACKGROUND: INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The value of INTERMACS profiling has not been shown for patients followed on medical therapy for advanced HF at centers that also offer mechanical circulatory support. METHODS AND RESULTS: This prospective, observational study enrolled 166 patients with chronic New York Heart Association class III-IV HF, ejection fraction ≤30%, and ≥1 HF hospitalization in the previous year, excluding patients listed for transplant or receiving chronic intravenous inotropic therapy. Subjects were followed for at least 12 months or until death, mechanical support, or transplant. Baseline features, quality of life, and outcomes were compared according to INTERMACS profile. Mean age was 57 years, ejection fraction 18%, and 57% had HF >5 years, whereas 23% of subjects were INTERMACS profile 4, 32% profile 5, and 45% profile 6/7. At 1 year, only 47% of this ambulatory advanced HF cohort remained alive on medical therapy. Patients in INTERMACS profile 4 were more likely to die or require mechanical support, with only 52% of these patients alive without support after the first 6 months. Profile 6/7 patients had 1-year survival of 84%, similar to outcomes for contemporary destination left ventricular assist device recipients. Quality of life using the indexed EuroQol score was poor across profiles 4 to 7, although severe limitation was less common than for ambulatory patients enrolled in INTERMACS before ventricular assist device implantation. CONCLUSIONS: Ambulatory patients with systolic HF, a heavy symptom burden, and at least 1 recent HF hospitalization are at high risk for death or left ventricular assist device rescue. INTERMACS profiles help identify ambulatory patients with advanced HF who may benefit from current mechanical support devices under existing indications.
BACKGROUND: INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The value of INTERMACS profiling has not been shown for patients followed on medical therapy for advanced HF at centers that also offer mechanical circulatory support. METHODS AND RESULTS: This prospective, observational study enrolled 166 patients with chronic New York Heart Association class III-IV HF, ejection fraction ≤30%, and ≥1 HF hospitalization in the previous year, excluding patients listed for transplant or receiving chronic intravenous inotropic therapy. Subjects were followed for at least 12 months or until death, mechanical support, or transplant. Baseline features, quality of life, and outcomes were compared according to INTERMACS profile. Mean age was 57 years, ejection fraction 18%, and 57% had HF >5 years, whereas 23% of subjects were INTERMACS profile 4, 32% profile 5, and 45% profile 6/7. At 1 year, only 47% of this ambulatory advanced HF cohort remained alive on medical therapy. Patients in INTERMACS profile 4 were more likely to die or require mechanical support, with only 52% of these patients alive without support after the first 6 months. Profile 6/7 patients had 1-year survival of 84%, similar to outcomes for contemporary destination left ventricular assist device recipients. Quality of life using the indexed EuroQol score was poor across profiles 4 to 7, although severe limitation was less common than for ambulatory patients enrolled in INTERMACS before ventricular assist device implantation. CONCLUSIONS: Ambulatory patients with systolic HF, a heavy symptom burden, and at least 1 recent HF hospitalization are at high risk for death or left ventricular assist device rescue. INTERMACS profiles help identify ambulatory patients with advanced HF who may benefit from current mechanical support devices under existing indications.
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: Garrick C Stewart; Thomas Cascino; Blair Richards; Shokoufeh Khalatbari; Douglas L Mann; Wendy C Taddei-Peters; J Timothy Baldwin; Neal O Jeffries; Catherine Spino; Lynne W Stevenson; Keith D Aaronson Journal: JACC Heart Fail Date: 2019-05-08 Impact factor: 12.035
Authors: Keith D Aaronson; Garrick C Stewart; Francis D Pagani; Lynne W Stevenson; Maryse Palardy; Dennis M McNamara; Donna M Mancini; Kathleen Grady; John Gorcsan; Robert Kormos; Neal Jeffries; Wendy C Taddei-Peters; Blair Richards; Shokoufeh Khalatbari; Cathie Spino; J Timothy Baldwin; Douglas L Mann Journal: J Heart Lung Transplant Date: 2019-09-14 Impact factor: 10.247
Authors: Michelle M Kittleson; Palak Shah; Anuradha Lala; Rhondalyn C McLean; Salpy Pamboukian; Douglas A Horstmanshof; Jennifer Thibodeau; Keyur Shah; Jeffrey Teuteberg; Nisha A Gilotra; Wendy C Taddei-Peters; Thomas M Cascino; Blair Richards; Shokoufeh Khalatbari; Neal Jeffries; Lynne W Stevenson; Douglas Mann; Keith D Aaronson; Garrick C Stewart Journal: J Heart Lung Transplant Date: 2019-08-28 Impact factor: 10.247
Authors: K R Balakrishnan; K G Sureshrao; R Ravikumar; T Muralikrishna; K Ganapathy Subramaniam; R Mohan; A Ajay; K Ramasubramanian; D Jagdish; R Veena Journal: Indian Heart J Date: 2020-09-19