Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients

Estep, Jerry D.; Starling, Randall C.; Horstmanshof, Douglas; Milano, Carmelo A.; Selzman, Craig H.; Shah, Keyur B.; Loebe, Matthias; Moazami, Nader; Long, James W.; Stehlik, Josef; Kasirajan, Vigneshwar; Haas, Donald; O’Connell, John B.; Boyle, Andrew; Farrar, David J.; Rogers, Joseph G.; Investigators, Roadmap Study

doi:10.1016/j.jacc.2015.07.075

Cited by 299 publications

(105 citation statements)

References 20 publications

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“…18 The current study includes a greater proportion of INTERMACS profile 4 patients, for whom medical by guest on May 12, 2018 http://circheartfailure.ahajournals.org/ Downloaded from Profiles in Ambulatory Advanced Heart Failure therapy is more likely to fail early after enrollment. The average visual analog scale value for quality of life at baseline was 50 in this study, lower than the 60 reported in ROADMAP for the medically managed group.…”

Section: Discussionmentioning

confidence: 99%

“…20 The present study, along with the recently published industry-sponsored ROADMAP trial, addresses the important knowledge gap about how best to triage high-risk ambulatory patients in whom MCS can be used electively for long-term benefit with lower anticipated complication rates and improved cost-effectiveness. 18 For this less sick population in whom death is not imminent, shared decision making about MCS will require more measured and individualized consideration of risks and benefits beyond survival.…”

Section: Discussionmentioning

confidence: 99%

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

Stewart

Kittleson

Patel

et al. 2016

Circ: Heart Failure

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Stewart

Kittleson

Patel

et al. 2016

Circ: Heart Failure

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“…The recently published Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients (ROADMAP) observational study suggested benefit in terms of survival and quality of life despite increase in adverse events in patients who received a VAD compared with those treated with medical therapy. 63 It is important to note that this study was observational and that the patients who received a VAD were sicker than those who received medical therapy.…”

Section: Ventricular Assist Devicesmentioning

confidence: 99%

New Management Strategies in Heart Failure

Owens

Brozena

Jessup

2016

Circulation Research

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“…They suggested that patients had improved their health status, anxiety, and depression in the first few months after LVAD implantation and that those scores of patients receiving LVAD therapy were still below for physical, social, and emotional functioning compared with transplant recipients. After Brouwer's study, some studies [28,29] found decreasing of anxiety/depression after introducing LVADs, but two studies [30,31], whose sample size were about 10, did not found the significant improvement in anxiety and depression. Higher scores on anxiety/ depression over time were associated with poor health status [32] and rehospitalization [33].…”

Section: Brouwers Et Al Reviewed Systematically 16 Quantitative Studmentioning

confidence: 99%

Anxiety and Depression in Cardiovascular Surgery

Okamoto¹,

Motomura²

2017

Depression

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Although anxiety and depression are psychological risk factors for coronary artery disease (CAD), psychological aspect in patients with cardiovascular surgery has been less considered. Cognitive and psychological deficit has been still concerning in spite of notable improvement of cardiovascular surgery using cardiopulmonary bypass perfusion. The purpose of this chapter review is to discuss recent data concerning the prevalence and trend of anxiety and depression of patients with cardiovascular surgery and to introduce the nonpharmacological intervention studies. The prevalence of anxiety and depression of patients after cardiovascular surgeries has varied from 10 to 60% and has been likely higher than that of general people. From the limited studies about patients over 6 months after surgery, we guessed the followings about the trends of anxiety and depression of patients with CABG without any other additional intervention programs before/after surgery: (1) patients improved scores of anxiety and depression 3-6 months after surgery, (2) anxiety decreased considerably for about 6 months after CABG and then leveled out for some time, (3) depression remained a bit higher 6 months and more after CABG. Patients' longitudinal psychological conditions would have been influenced by not only invasive cardiovascular surgery but also life events. The nonpharmacology intervention would have improved patients' psychological conditions. Further research is needed to clarify the long-term psychological outcome and to develop the effective intervention programs toward patients with cardiovascular surgery.

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Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients

Cited by 299 publications

References 20 publications

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

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

New Management Strategies in Heart Failure

Anxiety and Depression in Cardiovascular Surgery

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