Abstract

This study investigated the use of Bayesian Networks (BNs) for left ventricular assist device (LVAD) therapy; a treatment for end-stage heart failure that has been steadily growing in popularity over the past decade. Despite this growth, the number of LVAD implants performed annually remains a small fraction of the estimated population of patients who might benefit from this treatment. We believe that this demonstrates a need for an accurate stratification tool that can help identify LVAD candidates at the most appropriate point in the course of their disease. We derived BNs to predict mortality at five endpoints utilizing the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database: containing over 12,000 total enrolled patients from 153 hospital sites, collected since 2006 to the present day, and consisting of approximately 230 pre-implant clinical variables. Synthetic minority oversampling technique (SMOTE) was employed to address the uneven proportion of patients with negative outcomes and to improve the performance of the models. The resulting accuracy and area under the ROC curve (%) for predicted mortality were 30 day: 94.9 and 92.5; 90 day: 84.2 and 73.9; 6 month: 78.2 and 70.6; 1 year: 73.1 and 70.6; and 2 years: 71.4 and 70.8. To foster the translation of these models to clinical practice, they have been incorporated into a web-based application, the Cardiac Health Risk Stratification System (CHRiSS). As clinical experience with LVAD therapy continues to grow, and additional data is collected, we aim to continually update these BN models to improve their accuracy and maintain their relevance. Ongoing work also aims to extend the BN models to predict the risk of adverse events post-LVAD implant as additional factors for consideration in decision making.

Highlights

  • Cardiac transplantation currently represents the most definitive treatment for end-stage heart failure (ESHF) with 90% 1-year survival and a 70% 5-year survival

  • The number of ESHF patients who may benefit from left ventricular assist devices (LVAD) therapy is between 80,000 and 200,000 annually. [1]

  • This study was conducted with a comprehensive dataset, known as the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). This is the largest national registry for U.S Food and Drug Administration (FDA) approved mechanical circulatory support devices that is jointly sponsored by the National Heart, Lung, and Blood Institute (NHLBI), Centers for Medicare and Medicaid Services (CMS), FDA and industry

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Summary

Introduction

Cardiac transplantation currently represents the most definitive treatment for end-stage heart failure (ESHF) with 90% 1-year survival and a 70% 5-year survival. There is a need for alternate therapies due to the limited supply of donor organs. For those ineligible for a heart transplant, or unable to wait, an alternative life-sparing therapy is to implant a left ventricular assist devices (LVAD). These devices have been used for nearly 25 years to support ESHF patients while awaiting transplant and have been consistently shown to improve mortality. The number of ESHF patients who may benefit from LVAD therapy is between 80,000 and 200,000 annually. The number of ESHF patients who may benefit from LVAD therapy is between 80,000 and 200,000 annually. [1]

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