Duration of Heart Failure Is an Important Predictor of Outcomes After Mechanical Circulatory Support. (September 2015)

• Record Type: Journal Article
• Authors: Loyaga-Rendon, Renzo Y.; Acharya, Deepak; Pamboukian, Salpy V.; Tallaj, Jose A.; Cantor, Ryan; Starling, Randall C.; Naftel, David C.; Kirklin, James K.
• Is Part Of: Circulation. Volume 8:Number 5(2015)
• Publication Date: 2015-09
• Subjects: Heart failure -- Periodicals; 616.129005
• DOI: 10.1161/CIRCHEARTFAILURE.115.002321
• Languages: English
• ISSNs: 1941-3289

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background—</title> <p>Heart failure (HF) progression results in worsening functional capacity and end-organ compromise. HF may occur acutely or be associated with a chronic presentation. We hypothesized that the duration of HF affects outcomes after mechanical circulatory support.</p> </sec> <sec> <title>Methods and Results—</title> <p>A total of 10 730 patients registered in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who received primary implant of a mechanical circulatory support device were stratified according to the duration of HF symptoms: acute HF (AHF; ⩽1 month), sub-AHF (1–12 months), and chronic HF (Cr-HF; ≥ 12 months). AHF patients were younger with a higher proportion of women and white and with a lower prevalence of peripheral vascular disease and history of prior cardiac surgeries. Sixty percent of AHF patients were INTERMACS profile 1 at the time of implantation versus 24% and 13.2% in the sub-AHF and Cr-HF groups, respectively (<italic>P</italic>=0.0001). Patients with AHF had the highest utilization of biventricular support (14.4%). The estimated survival at 4 years was 58%, 51%, and 45% for the AHF, sub-AHF, and Cr-HF patients (<italic>P</italic>=0.006). The proportion of patients with AHF who received heart transplantation at 1 year was 29% compared with 22.6% in the patients with Cr-HF. After adjustment for known risk factors of adverse outcome, patients with AHF have a better late phase prognosis compared with patients with Cr-HF (hazard ratio, 0.34; <italic>P</italic>=0.0003).</p> </sec> <sec> <title>Conclusions—</title> <p>The duration of HF before durable mechanical circulatory support implant is an important variable influencing outcome. Patients with AHF had improved survival at 4 years and higher rates of transplantation at 1 year despite higher acuity of presentation.</p> </sec> </abstract>