Abstract 8490: End Stage Heart Failure: Are We Missing Patients Who May Benefit from Left Ventricular Assist Device Support?
Introduction: Heart failure (HF) is associated with tremendous morbidity and mortality and presents a significant social and financial burden to the U.S and abroad. Prior studies of left ventricular assist device (LVAD) support focused mainly on inotrope requiring patients (INTERMACS levels 1-3). Given improvements in survival following LVAD implant, we hypothesize that there is a “less ill” cohort of HF patients whose estimated 1 year mortality may justify LVAD therapy.
Methods: This was a prospective multicenter observational study of patients (n=150) 18-80 years of age with non-inotrope dependent, chronic (>12 months) advanced HF who were not listed for cardiac transplant. All patients had an LVEF <30% and either two HF admissions in 1 year or one HF admission and at least one other high risk feature (peak oxygen consumption (pVO2) <55% predicted, 6-min walk (6MW) distance <300 m, BNP > 800 pg/mL, sodium <135 mg/dL, an ER/clinic visit for IV diuretic therapy). Baseline demographics, laboratories, and functional capacity were assessed. Seattle Heart Failure Model (SHFM) survival estimates following medical management of HF were calculated. Lietz-Miller (LMS) and HeartMate II Risk (HMIIR) scores were then calculated for estimation of survival following LVAD therapy.
Results: Mean±standard deviation patient age was 57±13 years, 71% were male, and mean HF duration was 7±5 years with a mean LVEF of 17±6%. Within 6 months, patients had a mean 2.3±1.0 HF hospitalizations and 18% had had an ICD shock. The mean BNP was 1074±1099 pg/mL and 85% and 15% were NYHA class III and IV, respectively. Mean pVO2 and 6MW values were 12.9±4.0 ml/kg min (54±35% predicted) and 251±127 m, respectively. A SHFM score >1.5 (17% estimated 1-yr mortality) was present in 36%, and 7% had a score >2.5 (39% estimated 1-yr mortality). Yet, HMIIR (mean score 0.28±0.51, 7% high risk) and LMS (mean score 7.9±4.7, 6% high risk) scores predicted good LVAD outcomes.
Conclusion: Within referral centers, we have identified a group of HF outpatients without inotropic therapy predicted to have high mortality on medical management but low risk following LVAD. This suggests there is a sizeable cohort of ambulatory patients not currently receiving LVAD therapy who could derive benefit.
- © 2011 by American Heart Association, Inc.