Abstract 14841: Definitions of Stage D Heart Failure and Survival: Comparing INTERMACS Profiles, ESC Criteria, and Physician Assessment
Introduction: Care for patients with stage D heart failure (HF) is becoming increasingly complex in the era of mechanical circulatory support (MCS). However, an operational consensus definition of stage D HF is currently lacking.
Hypothesis: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles better identify outpatients with stage D HF compared to European Society of Cardiology Heart Failure Association (ESC-HFA) criteria and physician assessment.
Methods: We evaluated 474 outpatients with systolic HF (ejection fraction [EF] <40%) who received care in Q1 2012 and have not previously received advanced therapies (age, 61±15 years; 35.4% women; 44.7% white, 46.8% black; EF 24±10%; 67.2% with ischemic heart disease; 6.3% on home inotropes). We applied INTERMACS profiles (defining stage D as profiles 2-5) and ESC-HFA criteria to identify stage D HF, and compared with physician-derived stage D identification based on evaluations for advanced therapies (MCS, heart transplant, or palliative care). We then compared 3-year mortality across definitions.
Results: INTERMACS profiles, ESC-HFA criteria, and physicians identified 50 (10.5%), 59 (12.4%), and 64 (13.5%) of 474 patients, respectively, as having stage D HF. Concordance between definitions was low, with κ=0.35 (optimal: 1.0). After a median of 3.1 years (1.6, 3.3), 95 patients died (3-year mortality: 21.4%). In addition, 24 patients received MCS and 11 received heart transplant. Mortality was 51.2%, 43.7%, and 34.5% for INTERMACS-, ESC-HFA-, and physician-identified stage D HF patients, respectively (Figure 1). The INTERMACS definition provided the best prognostic separation between stage D and C HF patients, as measured by the Royston’s R2 statistic (Figure 1).
Conclusions: INTERMACS profiles provide a reasonable alternative for the identification of stage D patients in ambulatory systolic HF populations and offer better prognostic information than the ESC-HFA criteria.
Author Disclosures: J.S. Hedley: None. A.S. Tahhan: None. A.A. McCue: None. J.B. Bjork: None. M. Yazdani: None. R. Al-Anbari: None. J. Butler: None. V.V. Georgiopoulou: None. A. Kalogeropoulos: None.
- © 2015 by American Heart Association, Inc.