INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy after Hospitalizations for Heart Failure

Garrick C. Stewart, Michelle M. Kittleson, Parag C. Patel, Jennifer A. Cowger, Chetan B. Patel, Maria M. Mountis, Frances L. Johnson, Maya E. Guglin, J. Eduardo Rame, Jeffrey J. Teuteberg, Lynne W. Stevenson

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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. Methods and 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.

Original languageEnglish (US)
Article numbere003032
JournalCirculation: Heart Failure
Volume9
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

Fingerprint

Registries
Hospitalization
Heart Failure
Heart-Assist Devices
Therapeutics
Quality of Life
Systolic Heart Failure
Transplants
Observational Studies
Prospective Studies
Equipment and Supplies
Survival

Keywords

  • Heart failure
  • hospitalization
  • outcome measures
  • quality of life
  • registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy after Hospitalizations for Heart Failure. / Stewart, Garrick C.; Kittleson, Michelle M.; Patel, Parag C.; Cowger, Jennifer A.; Patel, Chetan B.; Mountis, Maria M.; Johnson, Frances L.; Guglin, Maya E.; Rame, J. Eduardo; Teuteberg, Jeffrey J.; Stevenson, Lynne W.

In: Circulation: Heart Failure, Vol. 9, No. 11, e003032, 01.11.2016.

Research output: Contribution to journalArticle

Stewart, Garrick C. ; Kittleson, Michelle M. ; Patel, Parag C. ; Cowger, Jennifer A. ; Patel, Chetan B. ; Mountis, Maria M. ; Johnson, Frances L. ; Guglin, Maya E. ; Rame, J. Eduardo ; Teuteberg, Jeffrey J. ; Stevenson, Lynne W. / INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) Profiling Identifies Ambulatory Patients at High Risk on Medical Therapy after Hospitalizations for Heart Failure. In: Circulation: Heart Failure. 2016 ; Vol. 9, No. 11.
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abstract = "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. Methods and 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.",
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