The Society of Thoracic Surgeons Intermacs 2020 Annual Report

Molina, Ezequiel; Shah, Palak; Kiernan, Michael S.; Cornwell, William K.; Copeland, Hannah; Takeda, Koji; Fernández, Félix G.; Badhwar, Vinay; Habib, Robert H.; Jacobs, Jeffrey P.; Koehl, Devin; Kirklin, James K.; Pagani, Francis D.; Cowger, Jennifer

doi:10.1016/j.athoracsur.2020.12.038

Cited by 474 publications

(460 citation statements)

References 12 publications

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“…Only 20% of the patients included were female. This is not unusual for patients with terminal heart failure undergoing heart transplantation or LVAD implantation (36,37). However, it limits the reliability of the results in relation to female patients.…”

Section: Limitationsmentioning

confidence: 99%

Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure

Hedwig

Nemchyna

Stein³

et al. 2021

Front. Cardiovasc. Med.

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Objectives: The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in advanced heart failure.Background: Global work index (GWI) and global constructive work (GCW) are calculated by means of speckle tracking, blood pressure measurement, and a normalized reference curve. Their prognostic value in advanced heart failure is unknown.Methods: Cardiopulmonary exercise testing and echocardiography with assessment of GWI and GCW was performed in patients with advanced heart failure caused by ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular assist device, or heart transplantation.Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was 1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p = 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months (IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight underwent transplantation, and 19 underwent implantation of a left ventricular assist device. In the multivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI (hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as independent predictors of the endpoint. The cut-off value for predicting the outcome was 455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and 530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%).Conclusions: GWI and GCW are powerful predictors of outcome in patients with advanced heart failure.

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Section: Limitationsmentioning

confidence: 99%

Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure

Hedwig

Nemchyna

Stein³

et al. 2021

Front. Cardiovasc. Med.

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“…Intermacs data 13 (Online Data Supplement) were used to evaluate preoperative factors commonly used for risk adjustment. [17][18][19] Data files were additionally used for the following purposes: (1) The American Hospital Association annual file was used to identify the implanting hospital's location, number of beds, and transplant status; (2) diagnosis codes within Medicare Part A claims were used to sum the total number of the Elixhauser comorbidity index comorbidities 20,21 ; and (3) a hospital's overall VAD procedural volume was calculated on the basis of procedures identified in Medicare claims and the STS Intermacs. 11…”

Section: Patient Characteristicsmentioning

confidence: 99%

Interhospital variability in health care–associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries

Yang

Malani

Fetters

et al. 2022

The Journal of Thoracic and Cardiovascular Surgery

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Objective: The objective of this study was to investigate variations across hospitals in infection rates and associated costs, the latter reflected in 90-day Medicare payments. Despite high rates and expenditures of health care-associated infections associated with durable ventricular assist device implantation, few studies have examined interhospital variation and associated costs.Methods: Clinical data on 8688 patients who received primary durable ventricular assist devices from July 2008 to July 2017 from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n ¼ 120) were merged with postimplantation 90-day Medicare claims. Terciles of hospital-specific, risk-adjusted infection rates per 100 patient-months were estimated using Intermacs and associated with Medicare payments (among 5440 Medicare beneficiaries). Primary outcomes included infections within 90 days of implantation and Medicare payments.Results: There were 3982 infections identified among 27.8% (2417/8688) of patients developing an infection. The median (25th, 75th percentile) adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 (9.3, 19.5) and varied according to hospital (range, 0.0-35.6). Total Medicare payments from implantation to 90 days were 9.0% (absolute difference: $13,652) greater in high versus low infection tercile hospitals (P<.0001). The period between implantation to discharge accounted for 73.1% of the difference in payments during the implantation to 90-day period across terciles.Conclusions: Health care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures. Interventions targeting preventing infections could improve the value of durable ventricular assist device support from the societal and hospital perspectives.

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“…Of particular relevance to the care of patients undergoing HT, ventricular assist devices (VADs) have emerged over the past two decades as an invaluable tool in the management of end-stage HF. 22,23 VADs provide stabilization of HF prior to HT, allowing an increasing number of patients to survive until a suitable organ becomes available. VADs also facilitate physiologic convalescence and rehabilitation, which further increases the likelihood of a successful HT operation.…”

Section: Ped Iatri C He Art Failure and Ventricul Ar A Ss Is T De Vice Smentioning

confidence: 99%

Learning networks in pediatric heart failure and transplantation

O’Connor

Lorts

Kwiatkowski

et al. 2021

Pediatric Transplantation

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Heart transplantation (HT), first reported in children in 1967, 1 is the main therapy for end-stage heart failure (HF) in all age groups that can reverse HF symptoms and restore a normal quality of life in the majority of recipients. In the United States, approximately 500 HTs are performed annually in patients <18 years of age, a number that have plateaued in recent years. 2 Early outcomes after HT in children are quite favorable, with 90%-95% 1-year survival; furthermore, the majority of recipients report minimal limitations in activities of

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The Society of Thoracic Surgeons Intermacs 2020 Annual Report

Cited by 474 publications

References 12 publications

Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure

Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure

Interhospital variability in health care–associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries

Learning networks in pediatric heart failure and transplantation

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