Ayman Samman-Tahhan1, Jeffrey S Hedley2, Andrew A McCue1, Jonathan B Bjork3, Vasiliki V Georgiopoulou1, Alanna A Morris1, Javed Butler4, Andreas P Kalogeropoulos5. 1. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 2. Department of Cardiology, Cleveland Clinic, Cleveland, Ohio. 3. Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota. 4. Division of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York. 5. Division of Cardiology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, New York. Electronic address: andreas.kalogeropoulos@stonybrook.edu.
Abstract
OBJECTIVES: This study sought to evaluate INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles for prognostic use among ambulatory non-inotrope-dependent patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: Data for INTERMACS profiles and prognoses in ambulatory patients with HFrEF are limited. METHODS: We evaluated 3-year outcomes in 969 non-inotrope-dependent outpatients with HFrEF (EF: ≤40%) not previously receiving advanced HF therapies. Patients meeting an INTERMACS profile at baseline were classified as profile 7 (n = 348 [34.7%]); 146 patients (14.5%) were classified profile 6; and 52 patients (5.2%) were classified profile 4 to 5. Remaining patients were classified "stable Stage C" (n = 423 [42.1%]). RESULTS: Three-year mortality rate was 10.0% among stable Stage C patients compared with 21.8% among INTERMACS profile 7 (hazard ratio [HR] vs. Stage C: 2.45; 95% confidence interval [CI]: 1.64 to 3.66), 26.0% among profile 6 (HR: 3.93; 95% CI: 1.64 to 3.66), and 43.8% among profile 4 to 5 (HR: 6.35; 95% CI: 3.51 to 11.5) patients. Hospitalization rates for HF were 4-fold higher among INTERMACS profile 7 (38 per 100 patient-years; rate ratio [RR] vs. Stage C: 3.88; 95% CI: 2.70 to 5.35), 6-fold higher among profile 6 patients (54 per 100 patient-years; RR: 5.69; 95% CI: 3.72 to 8.71), and 10-fold higher among profile 4 to 5 patients (69 per 100 patient-years; RR: 9.96; 95% CI: 5.15 to 19.3) than stable Stage C patients (11 per 100 patient-years). All-cause hospitalization rates had similar trends. INTERMACS profiles offered better prognostic separation than NYHA functional classifications. CONCLUSIONS: INTERMACS profiles strongly predict subsequent mortality and hospitalization burden in non-inotrope-dependent outpatients with HFrEF. These simple profiles could therefore facilitate and promote advanced HF awareness among clinicians and planning for advanced HF therapies.
OBJECTIVES: This study sought to evaluate INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles for prognostic use among ambulatory non-inotrope-dependent patients with heart failure with reduced ejection fraction (HFrEF). BACKGROUND: Data for INTERMACS profiles and prognoses in ambulatory patients with HFrEF are limited. METHODS: We evaluated 3-year outcomes in 969 non-inotrope-dependent outpatients with HFrEF (EF: ≤40%) not previously receiving advanced HF therapies. Patients meeting an INTERMACS profile at baseline were classified as profile 7 (n = 348 [34.7%]); 146 patients (14.5%) were classified profile 6; and 52 patients (5.2%) were classified profile 4 to 5. Remaining patients were classified "stable Stage C" (n = 423 [42.1%]). RESULTS: Three-year mortality rate was 10.0% among stable Stage C patients compared with 21.8% among INTERMACS profile 7 (hazard ratio [HR] vs. Stage C: 2.45; 95% confidence interval [CI]: 1.64 to 3.66), 26.0% among profile 6 (HR: 3.93; 95% CI: 1.64 to 3.66), and 43.8% among profile 4 to 5 (HR: 6.35; 95% CI: 3.51 to 11.5) patients. Hospitalization rates for HF were 4-fold higher among INTERMACS profile 7 (38 per 100 patient-years; rate ratio [RR] vs. Stage C: 3.88; 95% CI: 2.70 to 5.35), 6-fold higher among profile 6 patients (54 per 100 patient-years; RR: 5.69; 95% CI: 3.72 to 8.71), and 10-fold higher among profile 4 to 5 patients (69 per 100 patient-years; RR: 9.96; 95% CI: 5.15 to 19.3) than stable Stage C patients (11 per 100 patient-years). All-cause hospitalization rates had similar trends. INTERMACS profiles offered better prognostic separation than NYHA functional classifications. CONCLUSIONS: INTERMACS profiles strongly predict subsequent mortality and hospitalization burden in non-inotrope-dependent outpatients with HFrEF. These simple profiles could therefore facilitate and promote advanced HF awareness among clinicians and planning for advanced HF therapies.
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: 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: Dragana Kosevic; Dominik Wiedemann; Petar Vukovic; Velibor Ristic; Julia Riebandt; Una Radak; Kersten Brandes; Peter Goettel; Hans-Dirk Duengen; Elvis Tahirovic; Tatjana Kottmann; Hans Werner Voss; Marija Zdravkovic; Svetozar Putnik; Jan D Schmitto; Johannes Mueller; Jesus Eduardo Rame; Miodrag Peric Journal: ESC Heart Fail Date: 2021-02-09