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Current Heart Failure Reports
Published in: Current Heart Failure Reports 5/2019

01-10-2019 | Heart Failure | Updates in Advanced Heart Failure (E. Rame and M. St. John Sutton, Section Editors)

Patient Selection for Destination LVAD Therapy: Predicting Success in the Short and Long Term

Authors: Alexander Michaels, Jennifer Cowger

Published in: Current Heart Failure Reports | Issue 5/2019

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Abstract

Purpose of Review

In this review, we discuss risk assessment of advanced heart failure (HF) patients as a referral guide for advanced HF therapies, including left ventricular assist device (LVAD) support and cardiac transplant.

Recent Findings

The frequency of LVAD implantation for the purpose of permanent “destination” therapy is growing and survival on LVAD support is now approximating 50% at 5 years. Ambulatory HF patients with HF functional limitations, end-organ dysfunction, inability to tolerate HF medications, frequent cardiac admissions, and ventricular dysrhythmias are at high risk for mortality with medical management alone. Simultaneously, LVAD survival is superior in patients implanted prior to the onset of cardiogenic shock and/or multisystem dysfunction.

Summary

Early referral (< 7% annual predicted mortality) of patients with systolic heart failure to an advanced heart failure specialist is critical for achieving long-term survival.
Literature
1.
Estep JD, Starling RC, Horstmanshof DA, Milano CA, Selzman CH, Shah KB, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: results from the ROADMAP study. J Am Coll Cardiol. 2015;66(16):1747–61.PubMed
2.
Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435–43.PubMed
3.
Stevenson LW, Miller LW, Desvigne-Nickens P, Ascheim DD, Parides MK, Renlund DG, et al. Left ventricular assist device as destination for patients undergoing intravenous inotropic therapy: a subset analysis from REMATCH (Randomized Evaluation of Mechanical Assistance in Treatment of Chronic Heart Failure). Circulation. 2004;110(8):975–81.PubMed
4.
Kalogeropoulos AP, Samman-Tahhan A, Hedley JS, McCue AA, Bjork JB, Markham DW, et al. Progression to stage D heart failure among outpatients with stage C heart failure and reduced ejection fraction. JACC Heart Fail. 2017;5(7):528–37.PubMed
5.
6.
•• Kormos RL, Cowger J, et al. Intermacs database annual report: evolving indications, outcomes, and scientific partnerships. JHLT 2019. Ann Thorac Surg 2019;in press. This document summarizes the survival and complication profile of patients undergoing approved LVAD implant in the USA.
7.
Kirklin JK, Pagani FD, Kormos RL, Stevenson LW, Blume ED, Myers SL, et al. Eighth annual INTERMACS report: special focus on framing the impact of adverse events. J Heart Lung Transplant. 2017;36(10):1080–6.PubMed
8.
•• Yancy CW, Januzzi JL Jr, Allen LA, Butler J, Davis LL, Fonarow GC, et al. 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: answers to 10 pivotal issues about heart failure with reduced ejection fraction: a report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol. 2018;71(2):201–30. Highlights key components in long-term management of heart failure patients including clues as to when to refer to a heart failure specialist to maximize patient outcomes. PubMed
9.
Fonarow GC. Updates to target: heart failure. In: American Heart Association Task Force on Practice G, editors. Get with the guidelines. 2017.
10.
Mandawat A, Rao SV. Percutaneous mechanical circulatory support devices in cardiogenic shock. Circ Cardiovasc Interv. 2017;10(5).
11.
• Starling RC, Estep JD, Horstmanshof DA, Milano CA, Stehlik J, Shah KB, et al. Risk assessment and comparative effectiveness of left ventricular assist device and medical management in Ambulatory Heart Failure Patients: the ROADMAP study 2-year results. JACC Heart Fail. 2017;5(7):518–27. This analysis captures the increased mortality in ambulatory patients with advanced heart failure. PubMed
12.
Echouffo-Tcheugui JB, Greene SJ, Papadimitriou L, Zannad F, Yancy CW, Gheorghiade M, et al. Population risk prediction models for incident heart failure: a systematic review. Circ Heart Fail. 2015;8(3):438–47.PubMed
13.
Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043–9.PubMed
14.
Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, et al. The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation. 2006;113(11):1424–33.PubMed
15.
O’Connor CM, Abraham WT, Albert NM, Clare R, Gattis Stough W, Gheorghiade M, et al. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2008;156(4):662–73.PubMed
16.
Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Kober L, Squire IB, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J. 2013;34(19):1404–13.PubMed
17.
Critsinelis AC, Kurihara C, Kawabori M, Sugiura T, Civitello AB, Morgan JA. Preoperative prealbumin level as a predictor of outcomes in patients who underwent left ventricular assist device implantation. Am J Cardiol. 2017;120(11):1998–2002.PubMed
18.
Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ. Adhere Scientific Advisory Committee SG, et al. Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA. 2005;293(5):572–80.PubMed
19.
Peterson PN, Rumsfeld JS, Liang L, Albert NM, Hernandez AF, Peterson ED, et al. A validated risk score for in-hospital mortality in patients with heart failure from the American Heart Association get with the guidelines program. Circ Cardiovasc Qual Outcomes. 2010;3(1):25–32.PubMed
20.
Packer M, O’Connor CM, Ghali JK, Pressler ML, Carson PE, Belkin RN, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. Prospective Randomized Amlodipine Survival Evaluation Study Group. N Engl J Med. 1996;335(15):1107–14.PubMed
21.
22.
Lanfear DE, Levy WC, Stehlik J, Estep JD, Rogers JG, Shah KB, et al. Accuracy of Seattle Heart Failure Model and HeartMate II Risk Score in non-inotrope-dependent advanced heart failure patients: insights from the ROADMAP study (risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients). Circ Heart Fail. 2017;10(5).
23.
Tzou WS, Tung R, Frankel DS, Vaseghi M, Bunch TJ, Di Biase L, et al. Ventricular tachycardia ablation in severe heart failure: an international ventricular tachycardia ablation center collaboration analysis. Circ Arrhythm Electrophysiol. 2017;10(1).
24.
Vergara P, Tung R, Vaseghi M, Brombin C, Frankel DS, Di Biase L, et al. Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival. Heart Rhythm. 2018;15(1):48–55.PubMed
25.
Du H, Wonggom P, Tongpeth J, Clark RA. Six-minute walk test for assessing physical functional capacity in chronic heart failure. Curr Heart Fail Rep. 2017;14(3):158–66.PubMed
26.
Malhotra R, Bakken K, D’Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC Heart Fail. 2016;4(8):607–16.PubMed
27.
• Cowger J, Sundareswaran K, Rogers JG, Park SJ, Pagani FD, Bhat G, et al. Predicting survival in patients receiving continuous flow left ventricular assist devices: the HeartMate II Risk Score. J Am Coll Cardiol. 2013;61(3):313–21. This is the first widely used risk score in the continuous flow LVAD era. PubMed
28.
Cowger JA, Castle L, Aaronson KD, Slaughter MS, Moainie S, Walsh M, et al. The HeartMate II Risk Score: an adjusted score for evaluation of all continuous-flow left ventricular assist devices. ASAIO J. 2016;62(3):281–5.PubMed
29.
Lietz K, Long JW, Kfoury AG, Slaughter MS, Silver MA, Milano CA, et al. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection. Circulation. 2007;116(5):497–505.PubMed
30.
Atluri P, Goldstone AB, Fairman AS, MacArthur JW, Shudo Y, Cohen JE, et al. Predicting right ventricular failure in the modern, continuous flow left ventricular assist device era. Ann Thorac Surg. 2013;96(3):857–63 discussion 63-4.PubMedPubMedCentral
31.
Critsinelis A, Kurihara C, Volkovicher N, Kawabori M, Sugiura T, Manon M 2nd, et al. MELD-XI scoring system to predict outcomes in patients who undergo LVAD implantation. Ann Thorac Surg. 2018;106:513–9.PubMed
32.
• Kanwar MK, Lohmueller LC, Kormos RL, Teuteberg JJ, Rogers JG, Lindenfeld J, et al. A Bayesian model to predict survival after left ventricular assist device implantation. JACC Heart Fail. 2018;6(9):771–9. This analysis uses machine learning to examine mortality predictors in LVAD patients. PubMedPubMedCentral
33.
Kormos RL, Teuteberg JJ, Pagani FD, Russell SD, John R, Miller LW, et al. Right ventricular failure in patients with the HeartMate II continuous-flow left ventricular assist device: incidence, risk factors, and effect on outcomes. J Thorac Cardiovasc Surg. 2010;139(5):1316–24.PubMed
34.
Loghmanpour NA, Kormos RL, Kanwar MK, Teuteberg JJ, Murali S, Antaki JF. A Bayesian model to predict right ventricular failure following left ventricular assist device therapy. JACC Heart Fail. 2016;4(9):711–21.PubMedPubMedCentral
35.
Matthews JC, Koelling TM, Pagani FD, Aaronson KD. The right ventricular failure risk score a pre-operative tool for assessing the risk of right ventricular failure in left ventricular assist device candidates. J Am Coll Cardiol. 2008;51(22):2163–72.PubMedPubMedCentral
36.
Matthews JC, Pagani FD, Haft JW, Koelling TM, Naftel DC, Aaronson KD. Model for end-stage liver disease score predicts left ventricular assist device operative transfusion requirements, morbidity, and mortality. Circulation. 2010;121(2):214–20.PubMedPubMedCentral
37.
Soliman OII, Akin S, Muslem R, Boersma E, Manintveld OC, Krabatsch T, et al. Derivation and validation of a novel right-sided heart failure model after implantation of continuous flow left ventricular assist devices: the EUROMACS (European Registry for Patients with Mechanical Circulatory Support) right-sided heart failure risk score. Circulation. 2018;137(9):891–906.PubMed
38.
Kanwar MK, Lohmueller LC, Kormos RL, Loghmanpour NA, Benza RL, Mentz RJ, et al. Low accuracy of the HeartMate Risk Score for predicting mortality using the INTERMACS registry data. ASAIO J. 2017;63(3):251–6.PubMedPubMedCentral
39.
Critsinelis A, Kurihara C, Volkovicher N, Kawabori M, Sugiura T, Manon M 2nd, et al. Model of end-stage liver disease-eXcluding international normalized ratio (MELD-XI) scoring system to predict outcomes in patients who undergo left ventricular assist device implantation. Ann Thorac Surg. 2018;106(2):513–9.PubMed
40.
Loghmanpour NA, Kanwar MK, Druzdzel MJ, Benza RL, Murali S, Antaki JF. A new Bayesian network-based risk stratification model for prediction of short-term and long-term LVAD mortality. ASAIO J. 2015;61(3):313–23.PubMedPubMedCentral
41.
Birati EY, Hanff TC, Maldonado D, Grandin EW, Kennel PJ, Mazurek JA, et al. Predicting long term outcome in patients treated with continuous flow left ventricular assist device: the Penn-Columbia Risk Score. J Am Heart Assoc. 2018;7(6).
42.
Cooper LB, Hammill BG, Allen LA, Lindenfeld J, Mentz RJ, Rogers JG, et al. Assessing frailty in patients undergoing destination therapy left ventricular assist device: observations from interagency registry for mechanically assisted circulatory support. ASAIO J. 2018;64(1):16–23.PubMed
43.
Dunlay SM, Park SJ, Joyce LD, Daly RC, Stulak JM, McNallan SM, et al. Frailty and outcomes after implantation of left ventricular assist device as destination therapy. J Heart Lung Transplant. 2014;33(4):359–65.PubMed
44.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMed
45.
Joseph SM, Manghelli JL, Vader JM, Keeney T, Novak EL, Felius J, et al. Prospective assessment of frailty using the Fried criteria in patients undergoing left ventricular assist device therapy. Am J Cardiol. 2017;120(8):1349–54.PubMed
46.
Kiernan MS, Sundareswaran KS, Pham DT, Kapur NK, Pereira NL, Strueber M, et al. Preoperative determinants of quality of life and functional capacity response to left ventricular assist device therapy. J Card Fail. 2016;22(10):797–805.PubMed
47.
Rockwood K, Mitnitski A. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med. 2011;27(1):17–26.PubMed
48.
Tse G, Gong M, Wong SH, Wu WKK, Bazoukis G, Lampropoulos K, et al. Frailty and clinical outcomes in advanced heart failure patients undergoing left ventricular assist device implantation: a systematic review and meta-analysis. J Am Med Dir Assoc. 2018;19(3):255–61 e1.PubMed
49.
Yost G, Tatooles A, Bhat G. Preoperative nutritional assessment with the prognostic nutrition index in patients undergoing left ventricular assist device implantation. ASAIO J. 2018;64(1):52–5.PubMed
50.
• Cowger JA, Naka Y, Aaronson KD, Horstmanshof D, Gulati S, Rinde-Hoffman D, et al. Quality of life and functional capacity outcomes in the MOMENTUM 3 trial at 6 months: a call for new metrics for left ventricular assist device patients. J Heart Lung Transplant. 2018;37(1):15–24. Emphasizes gains made in quality of life after LVAD implantation and the areas in which more research is needed for long-term patient well-being. PubMed
Metadata
Title
Patient Selection for Destination LVAD Therapy: Predicting Success in the Short and Long Term
Authors
Alexander Michaels
Jennifer Cowger
Publication date
01-10-2019
Publisher
Springer US
Keyword
Heart Failure
Published in
Current Heart Failure Reports / Issue 5/2019
Print ISSN: 1546-9530
Electronic ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-019-00434-1

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