A.C. Alba

Usefulness of the INTERMACS Scale to Predict Outcomes After Mechanical Assist Device Implantation

BACKGROUNDnThe Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) scale classifies advanced heart failure patients according to hemodynamic status. This study assessed the usefulness of the INTERMACS scale to predict outcomes in advanced heart failure patients undergoing mechanical circulatory support (MCS).nnnMETHODSnFifty-four patients underwent MCS implantation from 2001 to 2007. Group A included 27 patients at INTERMACS level 1 and 2. Group B included 27 at INTERMACS level 3 and 4. Patient characteristics pre-MCS implant, incidence of complications during support, and survival between groups were compared.nnnRESULTSnBefore MCS implantation, Group A had significantly lower cardiac index, mean arterial blood pressure, systolic pulmonary pressure, higher central venous pressure, and lower urine output (p < .05). After MCS, Group A had a lower incidence of infections (17% vs 46%; odds ratio [OR], 0.25, 95% confidence interval [CI], 0.06-0.6) and a higher incidence of liver injury (39% vs 11%; OR 5, 95% CI, 1.15-25). Mortality at 30 days was higher in Group A (38% vs 11%; OR, 4.8; 95% CI, 1.1-21); however, the mortality after 30 days post-MCS support was significantly higher in Group B (0% vs 18%, p < .05). Cox model showed overall survival was poorer in Group A (hazard ratio, 2.7; 95% CI, 1.1-7).nnnCONCLUSIONnINTERMACS levels identified patients at risk for developing complications after MCS support. INTERMACS is a valid score system that should be considered as a tool to assess patient profile and predict complications and mortality after MCS implantation.

The effect of ventricular assist devices on long‐term post‐transplant outcomes: a systematic review of observational studies

Ventricular assist device (VAD) therapy is widely used as a bridge to cardiac transplant. Studies addressing the effect of VADs on post‐transplant outcomes have shown conflicting results. It is imperative to review this evidence to inform clinical decision making and future research. Our aim was to systematically evaluate the effect of VAD therapy on long‐term post‐transplant outcomes in heart transplant recipients.

The Added Value of Exercise Variables in Heart Failure Prognosis

INTRODUCTIONnDiminished exercise capacity is a key symptom in heart failure (HF). Exercise predictors (peak VO2, VE/VCO2 slope, and oxygen uptake efficiency slope [OUES]) are prognostic markers but studied in isolation. We evaluated if these exercise variables offer additional prognostic value to clinical predictors in HF.nnnMETHODS AND RESULTSnThis was a single-institution retrospective cohort study of 517 consecutive HF patients. We used Cox proportional hazards modeling to determine the additional prognostic value of exercise variables on mortality, HF hospital admissions, and a composite outcome of ventricular assistance device (VAD) implantation, heart transplantation (HT), and death. During a mean follow-up of 2.7 years, 52 deaths, 47 HTs, and 19 VAD implantations occurred. After adjusting for age, New York Heart Association functional class, ejection fraction, body mass index, creatinine, and B-type natriuretic peptide, peak VO2 (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.85-0.96), OUES (HR 0.92, 95% CI 0.87-0.97), and VE/VCO2 (HR 1.03, 95% CI 1.01-1.05) were independent predictors of the composite outcome. Similar discriminatory capacity existed between the exercise variables (c-statistics 0.77, 0.78, and 0.78, respectively). Only VE/VCO2 was an independent predictor of admissions (HR 1.04, 95% CI 1.01-1.07), and only peak VO2 was an independent predictor of mortality (HR 0.90, 95% CI 0.84-0.98).nnnCONCLUSIONSnPeak VO2, OUES, and VE/VCO2 are independent predictors of HF prognosis over recognized clinical variables. However, no single exercise variable was superior.

Optimal medical treatment of cardiovascular risk factors: can we prevent the development of heart failure?

Coronary heart disease is the most common cause of heart failure. Its prevalence has increased mainly owing to the improved survival of patients after acute myocardial infarction. In patients with heart failure, the presence of coronary heart disease has been shown to be independently associated with worsened long-term outcomes, including hospitalizations and poor mortality. Coronary heart disease frequently coexists with several major risk factors for the onset and progression of heart failure, such as hypertension, diabetes, obesity and metabolic syndrome, among others. Medical efforts to reduce the incidence of heart failure burden in patients with coronary heart disease and other types of cardiomyopathies must be directed at the prevention of heart failure and coronary risk factors themselves, and not just at the improvement of the management of established disease. This article will address the impact of known risk factors in the development of coronary heart disease and heart failure.

131 Endothelial progenitor cells and functional capacity in heart failure patients

BACKGROUND: Prompt access to care that optimizes outcomes is crucial in the management of heart failure (HF). The Canadian Cardiology Society (CCS) recommends that patients should be seen within two weeks following an emergency department (ED) visit for HF. However, it is unknown whether lack of adherence to this benchmark translates into worse clinical outcomes. OBJECTIVE: The objective was to examine whether delay in consultation following an ED visit for HF was related to adverse outcomes/events (death, hospitalization or repeat ED visit). METHODS: Patients with a confirmed diagnosis of HF were recruited by nurses at 8 hospital EDs in Quebec, Canada. They were interviewed by telephone within 6 weeks of ED discharge and subsequently at 3 months and 6 months. They responded to questions related to use of health services, sociodemographic information, the Minnesota Living with Heart Failure Questionnaire, and the Stanford Self-Efficacy in Chronic Disease Questionnaire. Pertinent clinical variables were extracted from medical charts by trained nurses. We used Cox regression to analyze whether delayed medical follow-up following ED visit was associated with increased risk of adverse events independently of other clinical covariates. RESULTS: We recruited a total of 551 patients. The mean age was 75.5 11.0 years and 51% were males. Only 30% consulted with a physician for their HF within 2 weeks post ED visit. By 4 weeks, 51% consulted a physician. Over the 6 month follow-up, 25% returned to the ED, 23% were hospitalized, and 13.6% died. Patients who consulted a physician within 2 weeks of ED discharge had a non-significantly lower risk of adverse events (HR: 0.69, 95% CI 0.40-1.2). However, by 4 weeks, this relationship became statistically significant: patients who consulted a physician for their HF within 4 weeks were less likely to sustain an adverse event (HR: 0.59, 95% CI 0.36-0.97). In addition to late clinical follow up, factors associated with a higher risk of adverse event included worse Minnesota Score, HF with systolic dysfunction and previous myocardial infarction. CONCLUSION: Prompt follow-up post ED visit for HF is associated with lower risk for major adverse event. Adherence to current CCS benchmarks is crucial. There is an urgent need to improve the rate of medical consultation within 2 to 4 weeks following ED visit for patients with HF. Canadian Institutes of Health Research (CIHR)