Cesar Caraballo1, Ersilia M DeFilippis2, Shunichi Nakagawa3, Neal G Ravindra4, P Elliott Miller5, Catherine Mezzacappa6, Megan McCullough7, Jadry Gruen6, Andrew Levin6, Samuel Reinhardt5, Clancy Mullan7, Ayyaz Ali7, Mathew S Maurer2, Nihar R Desai8, Tariq Ahmad9, Veli K Topkara10. 1. Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut. 2. Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. 3. Adult Palliative Care, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. 4. Department of Molecular Biophysics and Biochemistry, Yale University School of Medicine, New Haven, Connecticut; Integrated Graduate Program in Physical and Engineering Biology, Yale University School of Medicine, New Haven, Connecticut. 5. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. 6. Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. 7. Section of Cardiovascular Surgery, Yale University School of Medicine, New Haven, Connecticut. 8. Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. 9. Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: tariq.ahmad@yale.edu. 10. Division of Cardiology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: vt2113@cumc.columbia.edu.
Abstract
OBJECTIVES: The purpose of this study was to examine outcomes after left ventricular assist device (LVAD) implantation in older adults (>75 years of age). BACKGROUND: An aging heart failure population together with improvements in mechanical circulatory support (MCS) technology have led to increasing LVAD implantations in older adults. However, data presenting age-specific outcomes are limited. METHODS: Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who required durable MCS between 2008 and 2017 were included. Patients were stratified by 4 age groups: <55 years of age, 55 to 64 years of age, and >75 years of age. Kaplan-Meier survival estimates were used to assess post-LVAD outcomes, with log-rank testing used to compare groups. Univariate and multivariate cox proportional hazard regression models were used to determine predictors of survival and complications. RESULTS: A total of 20,939 individuals received an LVAD during the study period: 7,743 (37.0%) were <55 years of age, 6,755 (32.3%) were 55 to 64 years of age, 5,418 (25.9%) were 65 to 74 years of age, and 1,023 (4.9%) were ≥75 years of age or older. After multivariate adjustment, adults ≥75 years of age had increased mortality post-LVAD implantation. Elderly patients with LVADs had a higher incidence of gastrointestinal bleeding but lower rates of device thrombosis. Compared to 84.5% of patients <55 years of age who were discharged home, only 46.8% of adults ≥75 years of age were discharged home following implantation (p < 0.001). Use of a RVAD, serum albumin level, and 6-min walk test distances were identified as predictors of outcomes in the oldest cohort. CONCLUSIONS: Despite careful selection of older adults for LVAD implantation, age remains a significant predictor of mortality. Higher bleeding and lower clotting risk in elderly patients with LVADs support the use of a less intense antithrombotic regimen in this unique population.
OBJECTIVES: The purpose of this study was to examine outcomes after left ventricular assist device (LVAD) implantation in older adults (>75 years of age). BACKGROUND: An aging heart failure population together with improvements in mechanical circulatory support (MCS) technology have led to increasing LVAD implantations in older adults. However, data presenting age-specific outcomes are limited. METHODS: Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who required durable MCS between 2008 and 2017 were included. Patients were stratified by 4 age groups: <55 years of age, 55 to 64 years of age, and >75 years of age. Kaplan-Meier survival estimates were used to assess post-LVAD outcomes, with log-rank testing used to compare groups. Univariate and multivariate cox proportional hazard regression models were used to determine predictors of survival and complications. RESULTS: A total of 20,939 individuals received an LVAD during the study period: 7,743 (37.0%) were <55 years of age, 6,755 (32.3%) were 55 to 64 years of age, 5,418 (25.9%) were 65 to 74 years of age, and 1,023 (4.9%) were ≥75 years of age or older. After multivariate adjustment, adults ≥75 years of age had increased mortality post-LVAD implantation. Elderly patients with LVADs had a higher incidence of gastrointestinal bleeding but lower rates of device thrombosis. Compared to 84.5% of patients <55 years of age who were discharged home, only 46.8% of adults ≥75 years of age were discharged home following implantation (p < 0.001). Use of a RVAD, serum albumin level, and 6-min walk test distances were identified as predictors of outcomes in the oldest cohort. CONCLUSIONS: Despite careful selection of older adults for LVAD implantation, age remains a significant predictor of mortality. Higher bleeding and lower clotting risk in elderly patients with LVADs support the use of a less intense antithrombotic regimen in this unique population.
Authors: Yana Roka-Moiia; Kaitlyn R Ammann; Samuel Miller-Gutierrez; Alice Sweedo; Daniel Palomares; Joseph Italiano; Jawaad Sheriff; Danny Bluestein; Marvin J Slepian Journal: J Biomech Date: 2021-04-27 Impact factor: 2.789
Authors: Katherine C Michelis; Lin Zhong; Matthias Peltz; Ambarish Pandey; W H Wilson Tang; Anand Rohatgi; James B Young; Mark H Drazner; Justin L Grodin Journal: J Am Heart Assoc Date: 2020-07-10 Impact factor: 5.501
Authors: Luise Roehrich; Simon H Sündermann; Isabell Anna Just; Laurenz Kopp Fernandes; Julia Stein; Natalia Solowjowa; Johanna Mulzer; Marcus Mueller; Manfred Hummel; Jan Knierim; Evgenij Potapov; Volkmar Falk; Felix Schoenrath Journal: ESC Heart Fail Date: 2022-01-06
Authors: Sebastian Roth; René M'Pembele; Alexandra Stroda; Josephine Voit; Giovanna Lurati Buse; Stephan U Sixt; Ralf Westenfeld; Amin Polzin; Philipp Rellecke; Igor Tudorache; Markus W Hollmann; Udo Boeken; Payam Akhyari; Artur Lichtenberg; Ragnar Huhn; Hug Aubin Journal: ESC Heart Fail Date: 2022-05-05