Abstract 14709: Need for Triage in Advanced Heart Failure
Ventricular assist devices (VAD) and heart transplantation (OHT) improve survival and quality of life in highly-selected patients (pts), but thresholds for considering ambulatory pts for advanced therapies remain unclear. This study compares clinical characteristics and outcomes of ambulatory advanced heart failure (HF) pts without evaluation for OHT or VAD compared to evaluated pts. The MedaMACS Pilot Study enrolled 167 pts with chronic NYHA Class III/IV HF, EF ≤30%, and ≥1 HF hospitalization in the prior year, consistent with INTERMACS profiles 4-7. Pts were not eligible if listed for OHT or on chronic inotropes. Baseline data was collected from usual care. Pts were followed for 6 months, or until death or transplant. Pts were divided based on the treating physician’s decision to proceed with evaluation: OHT (OHT-eval), destination therapy VAD (DT-VAD-eval), and medical management without further evaluation (MED). Clinical characteristics and outcomes were compared. Of 167 pts, 59 (35%) were OHT-eval, 22 (13%) DT-VAD-eval, and 86 (52%) MED. There were no significant differences in age, sex, race, medications, NYHA class, or INTERMACS profile. The DT-VAD-eval group had more pts with BMI > 35kg/m2 (29% vs 4% in OHT-eval and 27% in MED; p = 0.003). There were no differences in diabetes, cerebrovascular or peripheral vascular disease, renal insufficiency, substance use, or reported noncompliance. Hemodynamics, including ejection fraction, pulmonary artery pressure, and cardiac index, did not differ. After 6 months, there was no significant difference in transplantation or survival (Table). The decision to evaluate HF pts for advanced therapies cannot be clearly delineated by clinical characteristics. Initial triage also does not impact outcomes of transplantation or death after 6 months. These results highlight the need for better characterization and triage of HF patients and timely evaluation of those most likely to benefit from transplantation and VADs.
- © 2012 by American Heart Association, Inc.