title: Duration of Heart Failure Is an Important Predictor of Outcomes After Mechanical Circulatory Support.
abstract: BACKGROUND
  Heart failure (HF) progression results in worsening functional capacity and end-organ compromise. HF may occur acutely or be associated with a chronic presentation. We hypothesized that the duration of HF affects outcomes after mechanical circulatory support.
  
  
  RESULTS
  A total of 10 730 patients registered in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who received primary implant of a mechanical circulatory support device were stratified according to the duration of HF symptoms: acute HF (AHF; ≤1 month), sub-AHF (1-12 months), and chronic HF (Cr-HF; ≥ 12 months). AHF patients were younger with a higher proportion of women and white and with a lower prevalence of peripheral vascular disease and history of prior cardiac surgeries. Sixty percent of AHF patients were INTERMACS profile 1 at the time of implantation versus 24% and 13.2% in the sub-AHF and Cr-HF groups, respectively (P=0.0001). Patients with AHF had the highest utilization of biventricular support (14.4%). The estimated survival at 4 years was 58%, 51%, and 45% for the AHF, sub-AHF, and Cr-HF patients (P=0.006). The proportion of patients with AHF who received heart transplantation at 1 year was 29% compared with 22.6% in the patients with Cr-HF. After adjustment for known risk factors of adverse outcome, patients with AHF have a better late phase prognosis compared with patients with Cr-HF (hazard ratio, 0.34; P=0.0003).
  
  
  CONCLUSIONS
  The duration of HF before durable mechanical circulatory support implant is an important variable influencing outcome. Patients with AHF had improved survival at 4 years and higher rates of transplantation at 1 year despite higher acuity of presentation.
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.). rloyagar@uab.edu.
authors.forename: Renzo Y
authors.initials: RY
authors.lastname: Loyaga-Rendon
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: Deepak
authors.initials: D
authors.lastname: Acharya
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: Salpy V
authors.initials: SV
authors.lastname: Pamboukian
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: Jose A
authors.initials: JA
authors.lastname: Tallaj
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: Ryan
authors.initials: R
authors.lastname: Cantor
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: David C
authors.initials: DC
authors.lastname: Naftel
authors.affiliation: From the Division of Cardiovascular Diseases, Department of Medicine (R.Y.L.-R., D.A., S.V.P., J.A.T.), Division of Cardiothoracic Surgery, Department of Surgery (R.C.), and Department of Epidemiology, School of Public Health (R.C.), and Division of Cardiothoracic Surgery (D.N., J.K.), University of Alabama at Birmingham; and Section of Heart Failure, Department of Medicine, Cleveland Clinic Foundation, OH (R.C.S.).
authors.forename: James K
authors.initials: JK
authors.lastname: Kirklin
mesh_terms: D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: heart failure; heart transplantation; humans; risk factors; ventricular assist device