Details

Autor(en) / Beteiligte

• Fendler, Timothy J., MD, MS
• Nassif, Michael E., MD
• Kennedy, Kevin F., MS
• Joseph, Susan M., MD
• Silvestry, Scott C., MD
• Ewald, Gregory A., MD
• LaRue, Shane J., MD, MPHS
• Vader, Justin M., MD, MPHS
• Spertus, John A., MD, MPH
• Arnold, Suzanne V., MD, MHA

Titel

Global Outcome in Patients with Left Ventricular Assist Devices

Ist Teil von

• The American journal of cardiology, 2017-04, Vol.119 (7), p.1069-1073

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract LVADs improve survival and quality of life (QOL) for most, but not all, patients with advanced heart failure. We described a broader definition of poor outcomes post-LVAD, using a novel composite of death, QOL, and other major adverse events. We evaluated the frequency of poor global outcome at 1 year post-LVAD among 164 patients (86% INTERMACS Profile 1-2; shock or declining despite inotropes) at a high-volume center. Poor global outcome (comprising death, poor QOL [KCCQ <45], recurrent heart failure [≥2 heart failure readmissions], or severe stroke) occurred in 58 (35%) patients: 37 died, 17 had poor QOL, 3 had recurrent heart failure, and 1 had a severe stroke. Patients with poor global outcomes were more likely designated for destination therapy (46% vs. 24%, p=0.01), spent more days hospitalized per month alive (median [IQR], 18.6[5.0-31.0] vs. 3.7[1.8-8.3], p<0.001), and had higher intracranial (12% vs. 2%, p=0.031) and gastrointestinal (44% vs. 28%, p=0.056) hemorrhage rates over the year post-implant. While LVADs often improve survival and QOL, ∼1/3 of high acuity patients experienced a poor global outcome over the year post-LVAD. In conclusion, composite outcomes may better capture events that matter to patients with LVADs and thus support informed decisions about pursuing LVAD therapy.