title: Ventricular Assist Device Therapy in Older Patients With Heart Failure: Characteristics and Outcomes.
abstract: BACKGROUND
  Limited data exist on outcomes in patients ≥70 years of age supported with the use of continuous-flow left ventricular assist devices (LVADs).
  
  
  METHODS
  Data on 1149 continuous-flow LVAD recipients was queried from the Mechanical Circulatory Support Research Network. Groups were assigned based on age: ≥70 years ("older patients") and <70 years. The primary outcome was survival at one-year based on age grouping.
  
  
  RESULTS
  Compared with younger patients (54.3 ± 11.2 y; n = 986), older patients (73.4 ± 3.0 y) constituted only 14% of LVAD implants. Older patients had similar rates of device thrombosis (P = .47) and stroke (P = .44), but survival-free of gastrointestinal bleeding (GIB) at 1 year was lower compared with younger patients (58% vs 69%; P < .01). Unadjusted survival at 1 year in older patients was 75% compared with 84% in younger patients, and at 2 years 65% versus 73% (P = .18). Age ≥70 years was not associated with increased mortality (adjusted hazard ratio [aHR] 0.94, 95% confidence interval [CI] 0.70-1.26; P = .67). Preoperative creatinine (aHR 1.57, 95% CI: 1.30-1.89, P < .0001), bilirubin (aHR 1.22, 95% CI 1.05-1.42; P = .010), and ischemic cardiomyopathy (aHR 1.43, 95% CI 1.11-1.84; P = .005) portended increased risk of death. In older patients, the only predictor of mortality was creatinine (HR 2.1, 95% CI 1.2-3.4; P = .007). Creatinine ≥1.4 mg/dL was associated with a 1-year survival of 65%, compared with 84% when the creatinine was <1.4 mg/dL (P = .009).
  
  
  CONCLUSIONS
  Age >70 years is an important consideration when assessing LVAD risk, but other correlates may be more predictive of LVAD survival. Older patients without renal dysfunction have survival similar to younger patients. Older patients should be counseled about age-correlated risks, including higher rates of GIB.
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Ju H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Singh
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Virginia.
authors.forename: Shashank S
authors.initials: SS
authors.lastname: Desai
authors.affiliation: Vanderbilt University, Nashville, Tennessee.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Haglund
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: Simon
authors.initials: S
authors.lastname: Maltais
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Aaronson
authors.affiliation: Mayo Clinic College of Medicine, Rochester, Minnesota.
authors.forename: John M
authors.initials: JM
authors.lastname: Stulak
authors.affiliation: Duke University, Durham, North Carolina.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Davis
authors.affiliation: St Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Salerno
authors.affiliation: St Vincent Heart Center of Indiana, Indianapolis, Indiana.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Cowger
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Virginia. Electronic address: palak.shah@inova.org.
authors.forename: Palak
authors.initials: P
authors.lastname: Shah
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Geriatrics; Heart failure; Left ventricular assist device; Mechanical circulatory support