Global Outcome in Patients With Left Ventricular Assist Devices.
Left ventricular assist devices (LVADs) improve survival and quality of life (QOL) for most, but not all, patients with advanced heart failure. We described a broader definition of poor outcomes after LVAD, using a novel composite of death, QOL, and other major adverse events. We evaluated the frequency of poor global outcome at 1 year after LVAD among 164 patients (86% Interagency Registry for Mechanically Assisted Circulatory Support profile 1 to 2; shock or declining despite inotropes) at a high-volume center. Poor global outcome (comprising death, poor QOL [Kansas City Cardiomyopathy Questionnaire <45], recurrent heart failure [≥2 heart failure readmissions], or severe stroke) occurred in 58 patients (35%): 37 died, 17 had poor QOL, 3 had recurrent heart failure, and 1 had a severe stroke. Patients with poor global outcomes were more likely designated for destination therapy (46% vs 24%, p = 0.01), spent more days hospitalized per month alive (median [interquartile range] 18.6 [5.0 to 31.0] vs 3.7 [1.8 to 8.3], p <0.001), and had higher intracranial (12% vs 2%, p = 0.031) and gastrointestinal (44% vs 28%, p = 0.056) hemorrhage rates over the year after implant. Although LVADs often improve survival and QOL, ∼1/3 of high-acuity patients experienced a poor global outcome over the year after LVAD. In conclusion, composite outcomes may better capture events that matter to patients with LVADs and thus support informed decisions about pursuing LVAD therapy.
Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: fendlert@umkc.edu.
Timothy J
TJ
Fendler
Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri.
Michael E
ME
Nassif
Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Kevin F
KF
Kennedy
Department of Cardiology, Baylor University Medical Center, Dallas, Texas.
Susan M
SM
Joseph
Department of Cardiovascular Surgery, Florida Hospital Transplant Institute, Florida Hospital, Orlando, Florida.
Scott C
SC
Silvestry
Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri.
Gregory A
GA
Ewald
Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri.
Shane J
SJ
LaRue
Department of Cardiology, Washington University School of Medicine, Saint Louis, Missouri.
Justin M
JM
Vader
Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri.
John A
JA
Spertus
Department of Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri.
Suzanne V
SV
Arnold
D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome