Effect of Age on Outcomes After Left Ventricular Assist Device Placement

Huang, Robert L.; Deng, Mario C.; Rogers, Joseph G.; Howser, Renee; Portner, Peer M.; Pierson, Richard N.; Butler, Javed

doi:10.1016/j.transproceed.2006.02.115

Cited by 26 publications

(26 citation statements)

References 3 publications

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“…105,106 These complications are particularly prevalent in the elderly. 107 Although patients often experience significant improvement in some of their symptoms, many other symptoms, including physical pain, major depression, and organic mental syndromes, may remain or occur de novo after VAD implantation. 108 Patients may also require significantly more support from caregivers.…”

Section: Ventricular Assist Devicesmentioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

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H eart failure is epidemic in developed countries and is expanding rapidly worldwide. Roughly 5% of patients with heart failure have end-stage disease that is refractory to medical therapy (stage D heart failure). 1 Palliative care consultation relieves symptoms, improves patient satisfaction, and decreases the costs of care for these patients. Despite this, only a small fraction of end-stage heart failure patients receive palliative care consultation. In recognition of this, palliative/hospice care referral was recommended for endstage heart failure (Level of Evidence 1A) in the most recent American College of Cardiology/American Heart Association heart failure guidelines. 2 To identify evidence-based studies of palliative care in heart failure, we searched the Medline database for literature with the medical subject headings "heart failure" and "palliative care," "supportive care," or "symptom management" and found 394 results. We identified 92 systematic reviews, 44 of which were English-language systematic reviews published within the past 5 years.

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Section: Ventricular Assist Devicesmentioning

confidence: 99%

Palliative Care in the Treatment of Advanced Heart Failure

et al. 2009

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“…Retrospective studies using contemporary continuous flow devices do not show an excess of stroke in elderly populations [11,15]. One report by Huang et al [8] suggests that patients aged [60 years had a higher incidence of serious infection and respiratory failure; however, his was not supported in two subsequent studies that implanted only continuous flow devices [11,15]. The incidence of renal failure requiring hemodialysis in older patients has not been well defined with the newer continuous flow devices, but results thus far have been discrepant [11,15].…”

Section: Morbiditymentioning

confidence: 95%

“…Advanced age is currently the most common contraindication to heart transplantation and affects one-third of all patients receiving MCS devices. In general, elderly patients who receive MCS tend to have a higher prevalence of ischemic cardiomyopathy [8][9][10], diabetes, and concomitant renal dysfunction than younger MCS recipients [11]. Quantifying the attributable risk of age on morbidity and mortality is complex and has been the subject of several retrospective analyses [8-10, 12, 13].…”

Section: Impact Of Age On Mcs Outcomesmentioning

confidence: 99%

“…1). When multivariate analysis of risk factors for death is undertaken, the majority of these retrospective studies suggests that older age is associated with increased mortality with odds ratios ranging from 1.9 to 3.9 (Table 2) [8,9,11,15,16]. The challenge in interpreting the association between age and mortality lies in whether there are residual confounders due to important unmeasured variables (e.g., frailty) that account for the association between older age and mortality post-MCS implantation.…”

Section: Mortalitymentioning

confidence: 99%

“…This association is likely related to the high prevalence of other independent predictors of bleeding in the elderly such as polypharmacy, renal dysfunction, history of cerebrovascular disease, history of GI bleeding, and anemia [20][21][22]. There is limited data directly comparing bleeding outcomes between MCS patients of different ages; however, the data do not suggest a large difference in major bleeding or hemorrhagic stroke in older patients [8,9,11,15]. Sander et al [11] found that post-MCS bleeding requiring surgery was not different between patients less than 60 years compared to those over 60 years of age (27% vs. 23%, P = ns).…”

Section: Morbiditymentioning

confidence: 99%

See 2 more Smart Citations

Mechanical circulatory support for elderly heart failure patients

Butler

Jugdutt

2012

Heart Fail Rev

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End-stage systolic heart failure is an increasingly common problem in elderly patients and is associated with high cost, poor quality of life, and poor outcomes. Mechanical circulatory support is a promising therapy as both a bridge to transplantation and destination therapy. Elderly patients are frequently ineligible for heart transplantation because of their age and comorbidities, and the application of mechanical circulatory support for destination therapy in this population is not well defined. A review of the literature was undertaken to better characterize our experience to date with mechanical circulatory support in older heart failure populations. Mechanical circulatory support is being employed increasingly for destination therapy indications in older patients. The newer continuous flow devices appear to have disproportionate advantage in elderly patients, which has translated into marked improvement in 1- and 2-year survival. The rational implementation of MCS devices in elderly heart failure patients needs to focus on (1) continuous flow devices that appear to have particular benefit in this population, (2) extensive pre-MCS assessment including variables relating to frailty, and (3) intervening before these patients develop cardiogenic shock. More data are needed on the cost-benefit analysis of routine use of CF devices as destination therapy in elderly patients with heart failure.

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Who Is an Appropriate Candidate for Long-Term MCS?: The Art of Patient Selection

Lai

Civitello

2017

Mechanical Circulatory Support for Advanced Heart Failure

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Effect of Age on Outcomes After Left Ventricular Assist Device Placement

Cited by 26 publications

References 3 publications

Palliative Care in the Treatment of Advanced Heart Failure

Palliative Care in the Treatment of Advanced Heart Failure

Mechanical circulatory support for elderly heart failure patients

Who Is an Appropriate Candidate for Long-Term MCS?: The Art of Patient Selection

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