Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices

Cowger, Jennifer; Sundareswaran, Kartik S.; Rogers, Joseph G.; Park, Soon J.; Pagani, Francis D.; Bhat, Geetha; Jaski, Brian E.; Farrar, David J.; Slaughter, Mark S.

doi:10.1016/j.jacc.2012.09.055

Cited by 295 publications

(231 citation statements)

References 21 publications

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“…Kidney dysfunction at time of LVAD implantation is associated with worse outcomes in other cohorts, although in those cases the dysfunction may reflect the severity of cardiac decompensation, and may be primarily acute 6, 22, 37. Many other investigations have focused on acute kidney injury complicating the LVAD implantation procedure, and on post‐implantation reductions in estimated glomerular filtration rate, and both are associated with poor outcomes 38.…”

Section: Discussionmentioning

confidence: 99%

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Walther

Niu

Winkelmayer

et al. 2018

JAHA

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BackgroundPeople with end‐stage renal disease (ESRD) are at risk for advanced heart failure, but little is known about use and outcomes of durable mechanical circulatory support in this setting. We examined use and outcomes of implantable ventricular assist devices (VADs) in a national ESRD cohort.Methods and ResultsWe performed a retrospective cohort study of Medicare beneficiaries with ESRD who underwent implantable VAD placement from 2006 to 2014. We examined in‐hospital and 1‐year mortality, all‐cause and cause‐specific hospitalizations, and heart/kidney transplantation outcomes. We investigated as predictors demographic factors, time‐period of VAD implantation, primary or post‐cardiotomy implantation, and duration of ESRD before VAD implantation. We identified 96 people with ESRD who underwent implantable VAD placement. At time of VAD implantation, 74 (77.1%) were receiving hemodialysis, 10 (10.4%) were receiving peritoneal dialysis and 12 (12.5%) had renal transplant. Time from incident ESRD to VAD implantation was median 4.0 (interquartile range 1.1, 8.2) years. Mortality during the implantation hospitalization was 40.6%. Within 1 year of implantation 61.5% of people had died. On multivariable analysis, males had half the mortality risk of females. Lower mortality risk was also seen with VAD implantation in a primary setting, and with more recent year of implantation, but these results did not reach statistical significance.ConclusionsMedicare beneficiaries with ESRD are undergoing durable VAD implantation, often several years after incident ESRD, although in low numbers. Mortality is high among these patients, highlighting the need for investigations to improve treatment selection and management.

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Section: Discussionmentioning

confidence: 99%

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Walther

Niu

Winkelmayer

et al. 2018

JAHA

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“…However, outcomes for patients with HF are highly variable, which makes clinical predictions challenging. Despite our clinical expertise and current prediction tools, the therapy with the best short-and long-term survival for the individual patient, particularly the sickest patient, is not easy to identify (18,32,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). A key reason is that among the most severely ill patients, most preoperative prediction tools in HF, critical care medicine and cardiac surgery have the tendency to be imprecise in estimating risk, particularly underestimating risk (41,47).…”

Section: Clinical Risk Prediction and Comparative Survival Benefit Ratimentioning

confidence: 99%

Current indications for transplantation: stratification of severe heart failure and shared decision-making

Vucicevic¹,

Honoris²,

Raia³

et al. 2018

Ann. Cardiothorac. Surg.

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Heart failure (HF) is a complex clinical syndrome that results from structural or functional cardiovascular disorders causing a mismatch between demand and supply of oxygenated blood and consecutive failure of the body's organs. For those patients with stage D HF, advanced therapies, such as mechanical circulatory support (MCS) or heart transplantation (HTx), are potentially life-saving options. The role of risk stratification of patients with stage D HF in a value-based healthcare framework is to predict which subset might benefit from advanced HF (AdHF) therapies, to improve outcomes related to the individual patient including mortality, morbidity and patient experience as well as to optimize health care delivery system outcomes such as costeffectiveness. Risk stratification and subsequent outcome prediction as well as therapeutic recommendationmaking need to be based on the comparative survival benefit rationale. A robust model needs to (I) have the power to discriminate (i.e., to correctly risk stratify patients); (II) calibrate (i.e., to show agreement between the predicted and observed risk); (III) to be applicable to the general population; and (IV) provide good external validation. The Seattle Heart Failure Model (SHFM) and the Heart Failure Survival Score (HFSS) are two of the most widely utilized scores. However, outcomes for patients with HF are highly variable which make clinical predictions challenging. Despite our clinical expertise and current prediction tools, the best short-and long-term survival for the individual patient, particularly the sickest patient, is not easy to identify because among the most severely ill, elderly and frail patients, most preoperative prediction tools have the tendency to be imprecise in estimating risk. They should be used as a guide in a clinical encounter grounded in a culture of shared decision-making, with the expert healthcare professional team as consultants and the patient as an empowered decision-maker in a trustful safe therapeutic relationship.

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“…2) HeartMate II Risk Score (HMRS) is a famous predictive tool for VAD candidates calculated as following: 0.0274 × Age -0.723 × Albumin (g/dL) + 0.74 × Creatinine (mg/dL) + 1.136 × PT-INR + 0.807 × (0 or 1, considering center volume). 14) When DT is adopted in elderly patients (≥65 years), they should be assigned to the low risk group (i.e. HMRS ≤1.58 points) to satisfy comparable outcome with the current Japanese BTT VAD therapy.…”

Section: Destination Therapymentioning

confidence: 99%

Indication of Ventricular Assist Device Therapy in Patients with INTERMACS Profile 4–7

Imamura

Kinugawa

2016

ATCS

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Predicting Survival in Patients Receiving Continuous Flow Left Ventricular Assist Devices

Abstract: The HMRS might be useful for mortality risk stratification in HMII candidates and may serve as an additional tool in the patient selection process.

Cited by 295 publications

References 21 publications

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Implantable Ventricular Assist Device Use and Outcomes in People With End‐Stage Renal Disease

Current indications for transplantation: stratification of severe heart failure and shared decision-making

Indication of Ventricular Assist Device Therapy in Patients with INTERMACS Profile 4–7

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