title: Clinical outcomes for continuous-flow left ventricular assist device patients stratified by pre-operative INTERMACS classification.
abstract: BACKGROUND
  Risk stratification for mechanical circulatory support (MCS) has emerged as an important tool in patient selection and outcomes assessment. Most studies examining risk stratification have been limited to pulsatile devices. We use the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) to stratify patients with continuous-flow devices and assess outcomes in less severe, but functionally impaired, heart failure patients.
  
  
  METHODS
  This study included 101 bridge-to-transplant and destination-therapy patients at 3 centers. Three groups were studied: Group 1, cardiogenic shock (INTERMACS Profile 1); Group 2, inotrope-dependent (INTERMACS Profile 2 or 3); and Group 3, ambulatory advanced heart failure (INTERMACS Profiles 4 to 7). The outcomes of interest were actuarial survival, survival to discharge and length of stay.
  
  
  RESULTS
  Survival at 36 months was better in Group 3 than in Group 1 (95.8% vs 51.1%, p = 0.011), but not between Groups 2 and 3 (68.8 vs 95.8%, p = 0.065). Lengths of stay for Groups 1 to 3 were 44, 41 and 17 days: Groups 1 vs 3, p < 0.001; Groups 2 vs 3, p < 0.001; and Groups 1 vs 2, p = 0.62. Lengths of stay for survivors were 49, 39 and 14 for the 3 groups: Groups 1 vs 3, p < 0.001; Groups 2 vs 3, p < 0.001; and Groups 1 vs 2, p = 0.28.
  
  
  CONCLUSIONS
  INTERMACS classification is a useful metric for risk-stratifying candidates for MCS. Less acutely ill but functionally impaired heart failure patients receiving continuous-flow LVADs had longer short- and long-term survival and shorter lengths of stay compared with patients who were more acutely ill.
authors.affiliation: Division of Cardiology, Aurora St. Luke's Medical Center, 2801 West Kinnickinnic River Parkway, Milwaukee, WI 53215, USA. andrew.boyle@aurora.org
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boyle
authors.forename: Deborah D
authors.initials: DD
authors.lastname: Ascheim
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Russo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kormos
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.forename: Annetine C
authors.initials: AC
authors.lastname: Gelijns
authors.forename: Kimberly N
authors.initials: KN
authors.lastname: Hong
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Teuteberg
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome