Abstract 374: Characteristics and Clinical Outcomes of Patients with Long-term Left Ventricular Assist Devices in Quebec Compared with the INTERMACS Registry

Abstract

Background: After a review of the evidence, our publicly funded cardiology evaluation unit recommended to the Quebec Ministry of Health that use of long-term left ventricular assist devices (LVAD) should be carefully monitored and not limited to bridge-to-transplant patients. Herein, we describe use and clinical outcomes of LVAD in Quebec during the latest 5-year period in comparison with results reported by the INTERMACS registry. Methods: A retrospective review of all pertinent hospital data sources of all LVAD-implanted patients in 2010-14 was performed with follow-up of major clinical outcomes to January 2015. Results: In Quebec’s 3 LVAD centers, 83 LVADs were implanted during 2010-14. Annual center patient volume varied from 0 to 24. Patients were mostly male (80%). Median age was 56 years (interquartile range, IQR: 45-62). The proportion of patients ≥ 60 years was 35% versus 49.5% in INTERMACS. For INTERMACS profiles that include inotrope dependence, the proportions of Quebec patients were very similar to INTERMACS for profile 1 (critical cardiogenic shock; 13% vs 15%, respectively) and profile 2 (progressive decline; 36% vs 36%) but higher for profile 3 (stable but inotrope dependent; 40% vs 30%). The proportion of patients who were not on the transplant list at the time of implantation was lower in Quebec (53%; 44/83) than in INTERMACS (78%) and destination therapy was much less frequent (11% [9/83] vs 43%). For patients implanted during 2010-13 (n=65), 1-year major clinical outcomes in Québec were very similar to INTERMACS (2006-2013): deaths, 17% vs 18%; cardiac transplantation, 22% vs 20%; LVAD removal because of myocardial recovery, 3% vs 1%; alive with LVAD support, 58% vs 61%. Clinical results at 1 year were similar for Quebec patients on and not on the transplant list at the time of implant (p=0.11). Two-thirds of the cohort had 2-year follow-up: 21% (12/56) died; 43% (24/56) had transplantation; 5% recovered and had LVAD removal; and 30% (17/56) were alive with LVAD. For patients implanted during 2014 (n=18), the median duration of follow-up was about 5 months and 5.6% had died on LVAD support. Among all Quebec patients (2010-2014), most recent follow-up indicates that 26% (9/32) of patients transplanted after LVAD support have died. Conclusions: In comparison with INTERMACS, Quebec LVAD patients were younger, more likely to be inotrope-dependent and less likely to be implanted as destination therapy. Despite relatively low center volumes, clinical outcomes for Quebec were very similar to INTERMACS. Results according to transplant list status at time of implant support the recommendation that transplant eligibility should not be an essential criterion for selection of patients for LVAD. Continued independent monitoring of LVAD patients, even after explant or transplant, will be important to optimize the value and quality of care of end-stage heart failure patients.