Abstract 11601: Identifying Patients at High Risk for Poor Global Outcome After Left Ventricular Assist Device for Destination Therapy: Results From the INTERMACS Registry

Abstract

Introduction: LVAD for destination therapy (DT-LVAD) improves survival and quality of life (QOL) for many, but not all, patients with end-stage heart failure who are ineligible for transplantation. To aid in decision-making and help calibrate patients’ expectations of recovery, we evaluated the frequency and predictors of poor global outcome using a composite measure that integrates QOL with mortality. Methods: Within the INTERMACS national registry, QOL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ-OS). Poor outcome was defined as death or an average KCCQ-OS <45 over the year following LVAD (i.e., continued NYHA IV symptoms despite LVAD). Inverse propensity weighting was used to adjust for loss to follow-up. Predictors of poor outcome were assessed using logistic regression with 18 demographic and clinical factors, with parameter estimates penalized to minimize the effect of over-fitting. Validation was conducted using bootstrap methods. Results: Among 1487 patients who underwent DT-LVAD, 30% had a poor outcome, with death in 23% and very poor QOL in 7%. Higher BMI (OR 1.12 per 5kg/m2, 95% CI 1.02-1.24), older age (OR 1.23 per 10y, 95% CI 1.08-1.40), and pre-implant poor QOL (OR 1.10 per 10pt lower KCCQ-OS, 95% CI 1.02-1.18) were significant predictors of poor global outcome, with trends for a history of cancer (OR 1.39, 95% CI 0.96-2.01) and INTERMACS profile 1-2 (i.e., critically ill with heart failure; OR 1.27, 95% CI 0.97-1.65). The model had moderate discrimination (c-index=0.64, validated=0.62), good calibration, and identified 10% of patients with a ≥40% risk of poor outcome. At 1 year, 33% of these high risk patients were dead and an additional 15% had very poor QOL. Conclusions: Nearly one-third of patients have poor outcomes over the year after DT-LVAD. We developed a simple predictive model that can identify patients’ risk for a poor global outcome after DT-LVAD to enable more realistic expectations of outcomes for individual patients.