INTERMACS profiles of advanced heart failure: the current picture.
BACKGROUND
The current classification of patients with New York Heart Association Class IV symptoms does not offer adequate description to allow optimal selection of patients for the current options of medical and pacing therapies, cardiac transplantation and mechanical circulatory support.


METHODS
Seven clinical profiles and an arrhythmia modifier were developed and implemented into the first year of data collection for the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). The INTERMACS Coordinators' Council provided ongoing feedback regarding the characterization of patients receiving implantable devices.


RESULTS
The definition of 7 clinical profiles revealed that 80% of current devices are being used in the 2 profiles with the highest levels of clinical compromise. The INTERMACS Coordinators' Council helped to identify gaps in the characterization of hospitalized patients on temporary assist devices and of homebound patients with resting symptoms, which has led to revised definitions of Profile 3 and 4 and the addition of 2 new modifiers, for temporary circulatory support devices in the hospital, and for frequent rehospitalization of patients at home.


CONCLUSIONS
Patients considered for mechanical circulatory support can now be classified using the 7 profiles plus 3 modifiers developed through INTERMACS. Further understanding these profiles and their impact on outcome should help to better select patients and therapies in the advanced stages of disease.
Stevenson
Lynne Warner
LW
Brigham & Women's Hospital, Boston, Massachusetts, USA.
Pagani
Francis D
FD
Young
James B
JB
Jessup
Mariell
M
Miller
Leslie
L
Kormos
Robert L
RL
Naftel
David C
DC
Ulisney
Karen
K
Desvigne-Nickens
Patrice
P
Kirklin
James K
JK
D018450:Disease Progression; D006333:Heart Failure / Q000145:classification* / Q000175:diagnosis / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D054555:National Heart, Lung, and Blood Institute (U.S.); D018579:Patient Selection; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States