title: Clinical outcomes after continuous-flow left ventricular assist device: a systematic review.
abstract: BACKGROUND
  Conveying the complex trade-offs of continuous-flow left ventricular assist devices is challenging and made more difficult by absence of an evidence summary for the full range of possible outcomes. We aimed to summarize the current evidence on outcomes of continuous-flow left ventricular assist devices.
  
  
  RESULTS
  PubMed and Cochrane Library were searched from January 2007 to December 2013, supplemented with manual review. Three reviewers independently assessed each study for saliency on patient-centered outcomes. Data were summarized in tabular form. Overall study characteristics encouraged inclusion of all indications (destination therapy and bridge to transplant) and prevented meta-analysis. The electronic search identified 465 abstracts, of which 50 met inclusion criteria; manual review added 2 articles in press. The articles included 10 industry-funded trials and registries, 10 multicenter reports, and the remainder single-center observational experiences. Estimated actuarial survival after continuous-flow left ventricular assist devices ranged from 56% to 87% at 1 year, 43% to 84% at 2 years, and 47% at 4 years. Improvements in functional class and quality of life were reported, but missing data complicated interpretation. Adverse events were experienced by the majority of patients, but estimates for bleeding, stroke, infection, right heart failure, arrhythmias, and rehospitalizations varied greatly.
  
  
  CONCLUSIONS
  The totality of data for continuous-flow left ventricular assist devices show consistent improvements in survival and quality of life counterbalanced by a range of common complications. Although this summary should provide a practical resource for healthcare provider-led discussions with patients, it highlights the critical need for high-quality patient-centered data collected with standard definitions.
authors.affiliation: From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.). colleen.mcilvennan@ucdenver.edu.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: McIlvennan
authors.affiliation: From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.).
authors.forename: Kate H
authors.initials: KH
authors.lastname: Magid
authors.affiliation: From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.).
authors.forename: Amrut V
authors.initials: AV
authors.lastname: Ambardekar
authors.affiliation: From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.).
authors.forename: Jocelyn S
authors.initials: JS
authors.lastname: Thompson
authors.affiliation: From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.).
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Matlock
authors.affiliation: From the Division of Cardiology (C.K.M., A.V.A., L.A.A.), Adult and Child Center for Health Outcomes Research and Delivery Science (K.H.M., J.S.T.), and Division of General Internal Medicine (D.D.M.), University of Colorado School of Medicine, Aurora; Brown University, School of Public Health, Providence, RI (K.H.M.); and Colorado Cardiovascular Outcomes Research Consortium, Denver (C.K.M., D.D.M., L.A.A.).
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
mesh_terms: D001243:Assisted Circulation / Q000379:methods; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D011474:Prosthesis Design; D011788:Quality of Life; D012042:Registries; D016896:Treatment Outcome
keywords: heart failure; heart-assist devices