Abstract 9248: The Impact of Heart Failure Progression on Post-Left Ventricular Assist Device Survival: An Analysis of the INTERMACS Registry
Background: Proper timing of implantation of continuous flow left ventricular assist devices (CF-LVAD) is an important management decision in patients with advancing heart failure (HF). Previous risk models derived from earlier generation rotary pump devices may not be applicable with CF-VADs. The purpose of this study was to develop a clinically applicable statistical model for predicting 1-year outcomes among patients with progressive HF receiving a CF-LVAD.
Methods: We analyzed data from all adult primary CF-LVAD (with or without RVAD) patients from June 2006 to December 2010 entered into the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database with 12 months of follow-up (n=2810). Variables entered into the statistical model included patient demographics, pre-implant laboratory data and clinical condition, device strategy, and INTERMACS level (1-7). Parametric proportional hazard analysis was used to identify risk factors for death.
Results: The significant (p < 0.05) components of the INTERMACS CF-VAD model are illustrated in the Table. As shown, BIVAD support, INTERMACS levels 1 and 2, and prior CABG imparted the highest risk of dying at 1 year. This model also revealed several modifiable risk factors, including BMI, nutritional status, renal and hepatic function, that predicted mortality after CF-VAD implantation. For example, the model predicts that a 10% worsening of renal and hepatic functions in a 45 year old bridge to transplant (BTT) candidate carries ~ 10.9% (13.8% to 15.3%) increased risk of dying at 1 year.
Conclusion: This risk model allows clinicians to weigh the “cost of waiting” to implant CF-LVADs in patients with advancing HF, and provides a simple method for determining the 1-year mortality in patients with advanced HF receiving a CF-LVAD.
- © 2012 by American Heart Association, Inc.