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Kittleson MM, Ambardekar AV, Stevenson LW, et al. An early relook identifies high-risk trajectories in ambulatory advanced heart failure. J Heart Lung Transplant. 2021;41(1):104-112doi: 10.1016/j.healun.2021.09.003.
Kittleson, M. M., Ambardekar, A. V., Stevenson, L. W., Gilotra, N. A., Shah, P., Ewald, G. A., Thibodeau, J. T., Stehlik, J., Palardy, M., Estep, J. D., Cascino, T. M., Baldwin, J. T., Jeffries, N., Khalatbari, S., Yosef, M., Peters, W. T., Richards, B., Mann, D. L., Aaronson, K. D., Stewart, G. C. (2022). An early relook identifies high-risk trajectories in ambulatory advanced heart failure. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, 41(1), 104-112. https://doi.org/10.1016/j.healun.2021.09.003
Kittleson, Michelle M, et al. "An early relook identifies high-risk trajectories in ambulatory advanced heart failure." The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation vol. 41,1 (2022): 104-112. doi: https://doi.org/10.1016/j.healun.2021.09.003
Kittleson MM, Ambardekar AV, Stevenson LW, Gilotra NA, Shah P, Ewald GA, Thibodeau JT, Stehlik J, Palardy M, Estep JD, Cascino TM, Baldwin JT, Jeffries N, Khalatbari S, Yosef M, Peters WT, Richards B, Mann DL, Aaronson KD, Stewart GC. An early relook identifies high-risk trajectories in ambulatory advanced heart failure. J Heart Lung Transplant. 2022 Jan;41(1):104-112. doi: 10.1016/j.healun.2021.09.003. Epub 2021 Sep 16. PMID: 34629234; PMCID: PMC8742755.
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J Heart Lung Transplant. 2022 Jan;41(1):104-112. doi: 10.1016/j.healun.2021.09.003. Epub 2021 Sep 16.

An early relook identifies high-risk trajectories in ambulatory advanced heart failure.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

Michelle M Kittleson, Amrut V Ambardekar, Lynne W Stevenson, Nisha A Gilotra, Palak Shah, Gregory A Ewald, Jennifer T Thibodeau, Josef Stehlik, Maryse Palardy, Jerry D Estep, Thomas M Cascino, J Timothy Baldwin, Neal Jeffries, Shokoufeh Khalatbari, Matheos Yosef, Wendy Taddei Peters, Blair Richards, Douglas L Mann, Keith D Aaronson, Garrick C Stewart,

Affiliations

  1. Department of Cardiology, Smidt Heart institute, Cedars-Sinai, Los Angeles, California. Electronic address: [email protected].
  2. Division of Cardiology, University of Colorado, Aurora, Colardo.
  3. Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center Nashville, Tennessee.
  4. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  5. Heart Failure & Transplantation, Inova Heart and Vascular Institute, Falls Church, Virginia.
  6. Department of Medicine, Division of Cardiology, Washington University School of Medicine, St Louis, Missouri.
  7. Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas, Texas.
  8. Division of Cardiovascular Medicine, University of Utah Health, University of Utah School of Medicine, Salt Lake City, Utah.
  9. Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
  10. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
  11. Michigan State University, East Lansing, Michigan.
  12. Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland.
  13. Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan.
  14. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
  15. Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

PMID: 34629234 PMCID: PMC8742755 DOI: 10.1016/j.healun.2021.09.003

Abstract

INTRODUCTION: Patients with ambulatory advanced heart failure (HF) are increasingly considered for durable mechanical circulatory support (MCS) and heart transplantation and their effective triage requires careful assessment of the clinical trajectory.

METHODS: REVIVAL, a prospective, observational study, enrolled 400 ambulatory advanced HF patients from 21 MCS/transplant centers in 2015-2016. Study design included a clinical re-assessment of Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile within 120 days after enrollment. The prognostic impact of a worsening INTERMACS Profile assigned by the treating physician was assessed at 1 year after the Early Relook.

RESULTS: Early Relook was done in 325 of 400 patients (81%), of whom 24% had a worsened INTERMACS Profile, associated with longer HF history and worse baseline INTERMACS profile, but no difference in baseline LVEF (median 0.20), 6-minute walk, quality of life, or other baseline parameters. Early worsening predicted higher rate of the combined primary endpoint of death, urgent MCS, or urgent transplant by 1 year after Early Relook, (28% vs 15%), with hazard ratio 2.2 (95% CI 1.2- 3.8; p = .006) even after adjusting for baseline INTERMACS Profile and Seattle HF Model score. Deterioration to urgent MCS occurred in 14% vs 5% (p = .006) during the year after Early Relook.

CONCLUSIONS: Early Relook identifies worsening of INTERMACS Profile in a significant population of ambulatory advanced HF, who had worse outcomes over the subsequent year. Early reassessment of ambulatory advanced HF patients should be performed to better define the trajectory of illness and inform triage to advanced therapies.

Copyright © 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Keywords: INTERMACS Profiles; LVAD; ambulatory heart failure; death; heart transplantation

Conflict of interest statement

Disclosure P.S. reports the following grant support: American Heart Association/Enduring Hearts Scientist Development Grant, Merck, Haemonetrics, and Medtronic. Consulting: NuPulse CV and Ortho Clinic

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