title: Risk assessment and comparative effectiveness of left ventricular assist device and medical management in ambulatory heart failure patients: design and rationale of the ROADMAP clinical trial.
abstract: BACKGROUND
  Mechanical circulatory support is now a proven therapy for the treatment of patients with advanced heart failure and cardiogenic shock. The role for this therapy in patients with less severe heart failure is unknown.
  
  
  OBJECTIVE
  The objective of this study is to examine the impact of mechanically assisted circulation using the HeartMate II left ventricular assist device in patients who meet current US Food and Drug Administration-defined criteria for treatment but are not yet receiving intravenous inotropic therapy.
  
  
  METHODS
  This is a prospective, nonrandomized clinical trial of 200 patients treated with either optimal medical management or a mechanical circulatory support device.
  
  
  METHODS
  This trial will be the first prospective clinical evaluation comparing outcomes of patients with advanced ambulatory heart failure treated with either ongoing medical therapy or a left ventricular assist device. It is anticipated to provide novel insights regarding relative outcomes with each treatment and an understanding of patient and provider acceptance of the ventricular assist device therapy. This trial will also provide information regarding the risk of events in "stable" patients with advanced heart failure and guidance for the optimal timing of left ventricular assist device therapy.
authors: Division of Cardiology, Duke University, Durham, NC. Electronic address: joseph.rogers@duke.edu.
authors: Joseph G
authors: JG
authors: Rogers
authors: Cleveland Clinic Florida, Weston, FL.
authors: Andrew J
authors: AJ
authors: Boyle
authors: Thoratec Corporation, Pleasanton, CA.
authors: John B
authors: JB
authors: O'Connell
authors: INTEGRIS Baptist Medical Center, Oklahoma City, OK.
authors: Douglas A
authors: DA
authors: Horstmanshof
authors: Abington Memorial Hospital, Abington, PA.
authors: Donald C
authors: DC
authors: Haas
authors: University of Louisville, Louisville, KY.
authors: Mark S
authors: MS
authors: Slaughter
authors: University Hospitals Case Medical Center, Cleveland, OH.
authors: Soon J
authors: SJ
authors: Park
authors: Thoratec Corporation, Pleasanton, CA.
authors: David J
authors: DJ
authors: Farrar
authors: Cleveland Clinic, Cleveland, OH.
authors: Randall C
authors: RC
authors: Starling
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D001243:Assisted Circulation / Q000295:instrumentation / Q000379:methods; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D057186:Comparative Effectiveness Research; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology
chemical_list: D002316:Cardiotonic Agents