Global Outcome in Patients With Left Ventricular Assist Devices

Timothy J. Fendler, Michael E. Nassif, Kevin F. Kennedy, Susan M. Joseph, Scott C. Silvestry, Gregory A. Ewald, Shane J. LaRue, Justin M. Vader, John A. Spertus, Suzanne V. Arnold

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1069-1073
Number of pages5
JournalAmerican Journal of Cardiology
Volume119
Issue number7
DOIs
StatePublished - Apr 1 2017

Fingerprint Dive into the research topics of 'Global Outcome in Patients With Left Ventricular Assist Devices'. Together they form a unique fingerprint.

  • Cite this

    Fendler, T. J., Nassif, M. E., Kennedy, K. F., Joseph, S. M., Silvestry, S. C., Ewald, G. A., LaRue, S. J., Vader, J. M., Spertus, J. A., & Arnold, S. V. (2017). Global Outcome in Patients With Left Ventricular Assist Devices. American Journal of Cardiology, 119(7), 1069-1073. https://doi.org/10.1016/j.amjcard.2016.12.014