INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy After Hospitalizations for Heart Failure.
BACKGROUND
INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) profiles provide important prognostic information for patients with advanced heart failure (HF) receiving mechanical support. The value of INTERMACS profiling has not been shown for patients followed on medical therapy for advanced HF at centers that also offer mechanical circulatory support.


RESULTS
This prospective, observational study enrolled 166 patients with chronic New York Heart Association class III-IV HF, ejection fraction ≤30%, and ≥1 HF hospitalization in the previous year, excluding patients listed for transplant or receiving chronic intravenous inotropic therapy. Subjects were followed for at least 12 months or until death, mechanical support, or transplant. Baseline features, quality of life, and outcomes were compared according to INTERMACS profile. Mean age was 57 years, ejection fraction 18%, and 57% had HF >5 years, whereas 23% of subjects were INTERMACS profile 4, 32% profile 5, and 45% profile 6/7. At 1 year, only 47% of this ambulatory advanced HF cohort remained alive on medical therapy. Patients in INTERMACS profile 4 were more likely to die or require mechanical support, with only 52% of these patients alive without support after the first 6 months. Profile 6/7 patients had 1-year survival of 84%, similar to outcomes for contemporary destination left ventricular assist device recipients. Quality of life using the indexed EuroQol score was poor across profiles 4 to 7, although severe limitation was less common than for ambulatory patients enrolled in INTERMACS before ventricular assist device implantation.


CONCLUSIONS
Ambulatory patients with systolic HF, a heavy symptom burden, and at least 1 recent HF hospitalization are at high risk for death or left ventricular assist device rescue. INTERMACS profiles help identify ambulatory patients with advanced HF who may benefit from current mechanical support devices under existing indications.
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.). gcstewart@partners.org.
Garrick C
GC
Stewart
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Michelle M
MM
Kittleson
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Parag C
PC
Patel
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Jennifer A
JA
Cowger
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Chetan B
CB
Patel
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Maria M
MM
Mountis
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Frances L
FL
Johnson
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Maya E
ME
Guglin
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
J Eduardo
JE
Rame
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Jeffrey J
JJ
Teuteberg
From the Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (G.C.S., L.W.S.); Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (M.M.K.); Department of Medicine, University of Texas Southwestern, Dallas, (P.C.P.); Department of Medicine, University of Michigan, Ann Arbor (J.A.C.); Department of Medicine, Division of Cardiology Duke University, Durham, NC (C.B.P.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (M.M.M.); Department of Medicine, University of Iowa, Iowa City (F.L.J.); Department of Cardiology, University of South Florida, Tampa (M.E.G.); Department of Medicine, Cardiology Division, University of Pennsylvania, Philadelphia (J.E.R.); Department of Medicine, Division of Cardiology, University of Pittsburgh, PA (J.J.T.).
Lynne W
LW
Stevenson
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D006830:Hydralazine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009566:Nitrates / Q000627:therapeutic use; D010045:Outpatients; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013318:Stroke Volume; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D009566:Nitrates; D049994:Sodium Potassium Chloride Symporter Inhibitors; D014665:Vasodilator Agents; D006830:Hydralazine
heart failure; hospitalization; outcome measures; quality of life; registries