Ventricular Assist Device Therapy in Older Patients With Heart Failure: Characteristics and Outcomes

Ju H. Kim, Ramesh Singh, Francis D. Pagani, Shashank S. Desai, Nicholas A. Haglund, Shannon M Dunlay, Simon Maltais, Keith D. Aaronson, John M. Stulak, Mary E. Davis, Christopher T. Salerno, Jennifer A. Cowger, Palak Shah

Research output: Contribution to journalArticle

15 Citations (Scopus)

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). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)981-987
Number of pages7
JournalJournal of Cardiac Failure
Volume22
Issue number12
DOIs
StatePublished - Dec 1 2016

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Heart-Assist Devices
Heart Failure
Therapeutics
Survival
Kidney
Research

Keywords

  • Geriatrics
  • Heart failure
  • Left ventricular assist device
  • Mechanical circulatory support

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ventricular Assist Device Therapy in Older Patients With Heart Failure : Characteristics and Outcomes. / Kim, Ju H.; Singh, Ramesh; Pagani, Francis D.; Desai, Shashank S.; Haglund, Nicholas A.; Dunlay, Shannon M; Maltais, Simon; Aaronson, Keith D.; Stulak, John M.; Davis, Mary E.; Salerno, Christopher T.; Cowger, Jennifer A.; Shah, Palak.

In: Journal of Cardiac Failure, Vol. 22, No. 12, 01.12.2016, p. 981-987.

Research output: Contribution to journalArticle

Kim, JH, Singh, R, Pagani, FD, Desai, SS, Haglund, NA, Dunlay, SM, Maltais, S, Aaronson, KD, Stulak, JM, Davis, ME, Salerno, CT, Cowger, JA & Shah, P 2016, 'Ventricular Assist Device Therapy in Older Patients With Heart Failure: Characteristics and Outcomes', Journal of Cardiac Failure, vol. 22, no. 12, pp. 981-987. https://doi.org/10.1016/j.cardfail.2016.10.004
Kim, Ju H. ; Singh, Ramesh ; Pagani, Francis D. ; Desai, Shashank S. ; Haglund, Nicholas A. ; Dunlay, Shannon M ; Maltais, Simon ; Aaronson, Keith D. ; Stulak, John M. ; Davis, Mary E. ; Salerno, Christopher T. ; Cowger, Jennifer A. ; Shah, Palak. / Ventricular Assist Device Therapy in Older Patients With Heart Failure : Characteristics and Outcomes. In: Journal of Cardiac Failure. 2016 ; Vol. 22, No. 12. pp. 981-987.
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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). Conclusion 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.",
keywords = "Geriatrics, Heart failure, Left ventricular assist device, Mechanical circulatory support",
author = "Kim, {Ju H.} and Ramesh Singh and Pagani, {Francis D.} and Desai, {Shashank S.} and Haglund, {Nicholas A.} and Dunlay, {Shannon M} and Simon Maltais and Aaronson, {Keith D.} and Stulak, {John M.} and Davis, {Mary E.} and Salerno, {Christopher T.} and Cowger, {Jennifer A.} and Palak Shah",
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TY - JOUR

T1 - Ventricular Assist Device Therapy in Older Patients With Heart Failure

T2 - Characteristics and Outcomes

AU - Kim, Ju H.

AU - Singh, Ramesh

AU - Pagani, Francis D.

AU - Desai, Shashank S.

AU - Haglund, Nicholas A.

AU - Dunlay, Shannon M

AU - Maltais, Simon

AU - Aaronson, Keith D.

AU - Stulak, John M.

AU - Davis, Mary E.

AU - Salerno, Christopher T.

AU - Cowger, Jennifer A.

AU - Shah, Palak

PY - 2016/12/1

Y1 - 2016/12/1

N2 - 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). Conclusion 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.

AB - 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). Conclusion 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.

KW - Geriatrics

KW - Heart failure

KW - Left ventricular assist device

KW - Mechanical circulatory support

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