Trends in long-term mechanical circulatory support for advanced heart failure in the UK
Aims Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report UK activity, trends, and outcome for long‐term VAD support as a bridging therapy to HTx. Methods and resu...
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| Veröffentlicht in: | European journal of heart failure 2013-10, Vol.15 (10), p.1185-1193 |
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| creator | Emin, Akan Rogers, Chris A. Parameshwar, Jayan MacGowan, Guy Taylor, Rhiannon Yonan, Nizar Simon, Andre Tsui, Steven Schueler, Stephan Banner, Nicholas R. Banner, Nicholas Braidley, Peter Burch, Mike Clark, Stephen Collett, Dave Cromwell, David Haire, Kate Mascaro, Jorge Parameshwar, Jayan Petrie, Mark Simon, Andre Tsui, Steven Yonan, Nizar Collins, Ms Katherine Haj-Yahia, Saleem MacGowan, Guy Shaw, Steven Schueler, Stephan Townsend, John Venkateswaran, Rajamiyer Wilson, Ian Winter, Mike |
| description | Aims
Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report UK activity, trends, and outcome for long‐term VAD support as a bridging therapy to HTx.
Methods and results
Patients were grouped into three eras: E1, February 2004–March 2006; E2, April 2006–March 2009; and E3, April 2009–March 2011. Exclusions were patients who received isolated short‐term support or extracorporeal membrane oxygenation without prior or subsequent long‐term VAD support. A total of 247 patients received VAD support; 202 left ventricular (LVAD) support alone and 45 both left and right ventricular support. Activity increased over time, from 36 patients implanted in E1 to 123 in E3. Overall, 46 patients received a first‐generation device, 80 a second‐generation device, and 121 a third‐generation device. Use of third‐generation devices increased from |
| doi_str_mv | 10.1093/eurjhf/hft127 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1437118518</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1437118518</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4827-1dfb674b932c117a968162cb690b9df60eb8adef66ea72e2a0e2eea8eb9230293</originalsourceid><addsrcrecordid>eNp9kLtOwzAUQC0EorxGVuSRJeBH4seIqpYCFSxFSCyW49yQlDyKnQD9e1qlMDL5yjr36OogdE7JFSWaX0Pvl0V-XeQdZXIPHVEldURUHO9vZq5UpFXMRug4hCUhVBLCDtGIcU0oScQRell4aLKAywZXbfMWdeBrXIMrbFM6W2FXetdXtmv9God-tWp9h_PWY5t92sZBhguw2y9bVr2HraYrAD8_nKKD3FYBznbvCXqeThbjWTR_ur0b38wjFysmI5rlqZBxqjlzlEqrhaKCuVRokuosFwRSZTPIhQArGTBLgAFYBalmnDDNT9Dl4F359qOH0Jm6DA6qyjbQ9sHQmEtKVULVBo0G1Pk2BA-5Wfmytn5tKDHblmZoaYaWG_5ip-7TGrI_-jfeBkgG4KusYP2_zUzuZ9PZdDGId4eUoYPvvz3r342QXCbm5fHWqHgsHuRrYmb8BwBHkvY</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1437118518</pqid></control><display><type>article</type><title>Trends in long-term mechanical circulatory support for advanced heart failure in the UK</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Wiley Free Content</source><source>Alma/SFX Local Collection</source><creator>Emin, Akan ; Rogers, Chris A. ; Parameshwar, Jayan ; MacGowan, Guy ; Taylor, Rhiannon ; Yonan, Nizar ; Simon, Andre ; Tsui, Steven ; Schueler, Stephan ; Banner, Nicholas R. ; Banner, Nicholas ; Braidley, Peter ; Burch, Mike ; Clark, Stephen ; Collett, Dave ; Cromwell, David ; Haire, Kate ; Mascaro, Jorge ; Parameshwar, Jayan ; Petrie, Mark ; Simon, Andre ; Tsui, Steven ; Yonan, Nizar ; Collins, Ms Katherine ; Haj-Yahia, Saleem ; MacGowan, Guy ; Shaw, Steven ; Schueler, Stephan ; Townsend, John ; Venkateswaran, Rajamiyer ; Wilson, Ian ; Winter, Mike</creator><creatorcontrib>Emin, Akan ; Rogers, Chris A. ; Parameshwar, Jayan ; MacGowan, Guy ; Taylor, Rhiannon ; Yonan, Nizar ; Simon, Andre ; Tsui, Steven ; Schueler, Stephan ; Banner, Nicholas R. ; Banner, Nicholas ; Braidley, Peter ; Burch, Mike ; Clark, Stephen ; Collett, Dave ; Cromwell, David ; Haire, Kate ; Mascaro, Jorge ; Parameshwar, Jayan ; Petrie, Mark ; Simon, Andre ; Tsui, Steven ; Yonan, Nizar ; Collins, Ms Katherine ; Haj-Yahia, Saleem ; MacGowan, Guy ; Shaw, Steven ; Schueler, Stephan ; Townsend, John ; Venkateswaran, Rajamiyer ; Wilson, Ian ; Winter, Mike ; Steering Group of the UK Cardiothoracic Transplant Audit ; on behalf of the Steering Group of the UK Cardiothoracic Transplant Audit and the UK VAD Forum</creatorcontrib><description>Aims
Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report UK activity, trends, and outcome for long‐term VAD support as a bridging therapy to HTx.
Methods and results
Patients were grouped into three eras: E1, February 2004–March 2006; E2, April 2006–March 2009; and E3, April 2009–March 2011. Exclusions were patients who received isolated short‐term support or extracorporeal membrane oxygenation without prior or subsequent long‐term VAD support. A total of 247 patients received VAD support; 202 left ventricular (LVAD) support alone and 45 both left and right ventricular support. Activity increased over time, from 36 patients implanted in E1 to 123 in E3. Overall, 46 patients received a first‐generation device, 80 a second‐generation device, and 121 a third‐generation device. Use of third‐generation devices increased from <6% in E1 to 78% in E3. Median duration of LVAD support increased from 141 days in E1 to 578 days in E3 (P < 0.001). Overall survival to 1 year after LVAD implant rose from 58.3% [95% confidence interval (CI) 40.7–72.4%] in E1 to 72.5% (95% CI 63.3–79.8%) in E3 (P = 0.21), and improved significantly with device generation; at 1 year, 50% of patients with first‐generation devices were alive compared with 68.1% and 76.9% of patients with second‐ and third‐generation devices, respectively (P = 0.002). These differences remained after risk adjustment. HTx following LVAD implant reduced over time (P < 0.001).
Conclusion
VAD activity and duration of support have increased. There has been a shift from first‐ and second‐ to third‐generation devices, and an associated improvement in survival.</description><identifier>ISSN: 1388-9842</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1093/eurjhf/hft127</identifier><identifier>PMID: 23901056</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Cardiomyopathy, Dilated - complications ; Cardiomyopathy, Dilated - mortality ; Cardiomyopathy, Dilated - therapy ; Cohort Studies ; ECMO ; Extracorporeal Membrane Oxygenation - trends ; Extracorporeal Membrane Oxygenation - utilization ; Female ; Heart Failure - etiology ; Heart Failure - mortality ; Heart Failure - therapy ; heart transplantation ; Heart Transplantation - utilization ; Heart-Assist Devices - trends ; Heart-Assist Devices - utilization ; Humans ; Intra-Aortic Balloon Pumping - trends ; Intra-Aortic Balloon Pumping - utilization ; Male ; mechanical circulatory support (MCS) ; Middle Aged ; Proportional Hazards Models ; Prospective Studies ; Severity of Illness Index ; survival ; Treatment Outcome ; United Kingdom ; ventricular assist device (VAD)</subject><ispartof>European journal of heart failure, 2013-10, Vol.15 (10), p.1185-1193</ispartof><rights>Published on behalf of the European Society of Cardiology. All rights reserved. © 2013 the Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4827-1dfb674b932c117a968162cb690b9df60eb8adef66ea72e2a0e2eea8eb9230293</citedby><cites>FETCH-LOGICAL-c4827-1dfb674b932c117a968162cb690b9df60eb8adef66ea72e2a0e2eea8eb9230293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1093%2Feurjhf%2Fhft127$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1093%2Feurjhf%2Fhft127$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,1428,27905,27906,45555,45556,46390,46814</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23901056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Emin, Akan</creatorcontrib><creatorcontrib>Rogers, Chris A.</creatorcontrib><creatorcontrib>Parameshwar, Jayan</creatorcontrib><creatorcontrib>MacGowan, Guy</creatorcontrib><creatorcontrib>Taylor, Rhiannon</creatorcontrib><creatorcontrib>Yonan, Nizar</creatorcontrib><creatorcontrib>Simon, Andre</creatorcontrib><creatorcontrib>Tsui, Steven</creatorcontrib><creatorcontrib>Schueler, Stephan</creatorcontrib><creatorcontrib>Banner, Nicholas R.</creatorcontrib><creatorcontrib>Banner, Nicholas</creatorcontrib><creatorcontrib>Braidley, Peter</creatorcontrib><creatorcontrib>Burch, Mike</creatorcontrib><creatorcontrib>Clark, Stephen</creatorcontrib><creatorcontrib>Collett, Dave</creatorcontrib><creatorcontrib>Cromwell, David</creatorcontrib><creatorcontrib>Haire, Kate</creatorcontrib><creatorcontrib>Mascaro, Jorge</creatorcontrib><creatorcontrib>Parameshwar, Jayan</creatorcontrib><creatorcontrib>Petrie, Mark</creatorcontrib><creatorcontrib>Simon, Andre</creatorcontrib><creatorcontrib>Tsui, Steven</creatorcontrib><creatorcontrib>Yonan, Nizar</creatorcontrib><creatorcontrib>Collins, Ms Katherine</creatorcontrib><creatorcontrib>Haj-Yahia, Saleem</creatorcontrib><creatorcontrib>MacGowan, Guy</creatorcontrib><creatorcontrib>Shaw, Steven</creatorcontrib><creatorcontrib>Schueler, Stephan</creatorcontrib><creatorcontrib>Townsend, John</creatorcontrib><creatorcontrib>Venkateswaran, Rajamiyer</creatorcontrib><creatorcontrib>Wilson, Ian</creatorcontrib><creatorcontrib>Winter, Mike</creatorcontrib><creatorcontrib>Steering Group of the UK Cardiothoracic Transplant Audit</creatorcontrib><creatorcontrib>on behalf of the Steering Group of the UK Cardiothoracic Transplant Audit and the UK VAD Forum</creatorcontrib><title>Trends in long-term mechanical circulatory support for advanced heart failure in the UK</title><title>European journal of heart failure</title><addtitle>European Journal of Heart Failure</addtitle><description>Aims
Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report UK activity, trends, and outcome for long‐term VAD support as a bridging therapy to HTx.
Methods and results
Patients were grouped into three eras: E1, February 2004–March 2006; E2, April 2006–March 2009; and E3, April 2009–March 2011. Exclusions were patients who received isolated short‐term support or extracorporeal membrane oxygenation without prior or subsequent long‐term VAD support. A total of 247 patients received VAD support; 202 left ventricular (LVAD) support alone and 45 both left and right ventricular support. Activity increased over time, from 36 patients implanted in E1 to 123 in E3. Overall, 46 patients received a first‐generation device, 80 a second‐generation device, and 121 a third‐generation device. Use of third‐generation devices increased from <6% in E1 to 78% in E3. Median duration of LVAD support increased from 141 days in E1 to 578 days in E3 (P < 0.001). Overall survival to 1 year after LVAD implant rose from 58.3% [95% confidence interval (CI) 40.7–72.4%] in E1 to 72.5% (95% CI 63.3–79.8%) in E3 (P = 0.21), and improved significantly with device generation; at 1 year, 50% of patients with first‐generation devices were alive compared with 68.1% and 76.9% of patients with second‐ and third‐generation devices, respectively (P = 0.002). These differences remained after risk adjustment. HTx following LVAD implant reduced over time (P < 0.001).
Conclusion
VAD activity and duration of support have increased. There has been a shift from first‐ and second‐ to third‐generation devices, and an associated improvement in survival.</description><subject>Adult</subject><subject>Cardiomyopathy, Dilated - complications</subject><subject>Cardiomyopathy, Dilated - mortality</subject><subject>Cardiomyopathy, Dilated - therapy</subject><subject>Cohort Studies</subject><subject>ECMO</subject><subject>Extracorporeal Membrane Oxygenation - trends</subject><subject>Extracorporeal Membrane Oxygenation - utilization</subject><subject>Female</subject><subject>Heart Failure - etiology</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - therapy</subject><subject>heart transplantation</subject><subject>Heart Transplantation - utilization</subject><subject>Heart-Assist Devices - trends</subject><subject>Heart-Assist Devices - utilization</subject><subject>Humans</subject><subject>Intra-Aortic Balloon Pumping - trends</subject><subject>Intra-Aortic Balloon Pumping - utilization</subject><subject>Male</subject><subject>mechanical circulatory support (MCS)</subject><subject>Middle Aged</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Severity of Illness Index</subject><subject>survival</subject><subject>Treatment Outcome</subject><subject>United Kingdom</subject><subject>ventricular assist device (VAD)</subject><issn>1388-9842</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kLtOwzAUQC0EorxGVuSRJeBH4seIqpYCFSxFSCyW49yQlDyKnQD9e1qlMDL5yjr36OogdE7JFSWaX0Pvl0V-XeQdZXIPHVEldURUHO9vZq5UpFXMRug4hCUhVBLCDtGIcU0oScQRell4aLKAywZXbfMWdeBrXIMrbFM6W2FXetdXtmv9God-tWp9h_PWY5t92sZBhguw2y9bVr2HraYrAD8_nKKD3FYBznbvCXqeThbjWTR_ur0b38wjFysmI5rlqZBxqjlzlEqrhaKCuVRokuosFwRSZTPIhQArGTBLgAFYBalmnDDNT9Dl4F359qOH0Jm6DA6qyjbQ9sHQmEtKVULVBo0G1Pk2BA-5Wfmytn5tKDHblmZoaYaWG_5ip-7TGrI_-jfeBkgG4KusYP2_zUzuZ9PZdDGId4eUoYPvvz3r342QXCbm5fHWqHgsHuRrYmb8BwBHkvY</recordid><startdate>201310</startdate><enddate>201310</enddate><creator>Emin, Akan</creator><creator>Rogers, Chris A.</creator><creator>Parameshwar, Jayan</creator><creator>MacGowan, Guy</creator><creator>Taylor, Rhiannon</creator><creator>Yonan, Nizar</creator><creator>Simon, Andre</creator><creator>Tsui, Steven</creator><creator>Schueler, Stephan</creator><creator>Banner, Nicholas R.</creator><creator>Banner, Nicholas</creator><creator>Braidley, Peter</creator><creator>Burch, Mike</creator><creator>Clark, Stephen</creator><creator>Collett, Dave</creator><creator>Cromwell, David</creator><creator>Haire, Kate</creator><creator>Mascaro, Jorge</creator><creator>Parameshwar, Jayan</creator><creator>Petrie, Mark</creator><creator>Simon, Andre</creator><creator>Tsui, Steven</creator><creator>Yonan, Nizar</creator><creator>Collins, Ms Katherine</creator><creator>Haj-Yahia, Saleem</creator><creator>MacGowan, Guy</creator><creator>Shaw, Steven</creator><creator>Schueler, Stephan</creator><creator>Townsend, John</creator><creator>Venkateswaran, Rajamiyer</creator><creator>Wilson, Ian</creator><creator>Winter, Mike</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201310</creationdate><title>Trends in long-term mechanical circulatory support for advanced heart failure in the UK</title><author>Emin, Akan ; Rogers, Chris A. ; Parameshwar, Jayan ; MacGowan, Guy ; Taylor, Rhiannon ; Yonan, Nizar ; Simon, Andre ; Tsui, Steven ; Schueler, Stephan ; Banner, Nicholas R. ; Banner, Nicholas ; Braidley, Peter ; Burch, Mike ; Clark, Stephen ; Collett, Dave ; Cromwell, David ; Haire, Kate ; Mascaro, Jorge ; Parameshwar, Jayan ; Petrie, Mark ; Simon, Andre ; Tsui, Steven ; Yonan, Nizar ; Collins, Ms Katherine ; Haj-Yahia, Saleem ; MacGowan, Guy ; Shaw, Steven ; Schueler, Stephan ; Townsend, John ; Venkateswaran, Rajamiyer ; Wilson, Ian ; Winter, Mike</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4827-1dfb674b932c117a968162cb690b9df60eb8adef66ea72e2a0e2eea8eb9230293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Cardiomyopathy, Dilated - complications</topic><topic>Cardiomyopathy, Dilated - mortality</topic><topic>Cardiomyopathy, Dilated - therapy</topic><topic>Cohort Studies</topic><topic>ECMO</topic><topic>Extracorporeal Membrane Oxygenation - trends</topic><topic>Extracorporeal Membrane Oxygenation - utilization</topic><topic>Female</topic><topic>Heart Failure - etiology</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - therapy</topic><topic>heart transplantation</topic><topic>Heart Transplantation - utilization</topic><topic>Heart-Assist Devices - trends</topic><topic>Heart-Assist Devices - utilization</topic><topic>Humans</topic><topic>Intra-Aortic Balloon Pumping - trends</topic><topic>Intra-Aortic Balloon Pumping - utilization</topic><topic>Male</topic><topic>mechanical circulatory support (MCS)</topic><topic>Middle Aged</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Severity of Illness Index</topic><topic>survival</topic><topic>Treatment Outcome</topic><topic>United Kingdom</topic><topic>ventricular assist device (VAD)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Emin, Akan</creatorcontrib><creatorcontrib>Rogers, Chris A.</creatorcontrib><creatorcontrib>Parameshwar, Jayan</creatorcontrib><creatorcontrib>MacGowan, Guy</creatorcontrib><creatorcontrib>Taylor, Rhiannon</creatorcontrib><creatorcontrib>Yonan, Nizar</creatorcontrib><creatorcontrib>Simon, Andre</creatorcontrib><creatorcontrib>Tsui, Steven</creatorcontrib><creatorcontrib>Schueler, Stephan</creatorcontrib><creatorcontrib>Banner, Nicholas R.</creatorcontrib><creatorcontrib>Banner, Nicholas</creatorcontrib><creatorcontrib>Braidley, Peter</creatorcontrib><creatorcontrib>Burch, Mike</creatorcontrib><creatorcontrib>Clark, Stephen</creatorcontrib><creatorcontrib>Collett, Dave</creatorcontrib><creatorcontrib>Cromwell, David</creatorcontrib><creatorcontrib>Haire, Kate</creatorcontrib><creatorcontrib>Mascaro, Jorge</creatorcontrib><creatorcontrib>Parameshwar, Jayan</creatorcontrib><creatorcontrib>Petrie, Mark</creatorcontrib><creatorcontrib>Simon, Andre</creatorcontrib><creatorcontrib>Tsui, Steven</creatorcontrib><creatorcontrib>Yonan, Nizar</creatorcontrib><creatorcontrib>Collins, Ms Katherine</creatorcontrib><creatorcontrib>Haj-Yahia, Saleem</creatorcontrib><creatorcontrib>MacGowan, Guy</creatorcontrib><creatorcontrib>Shaw, Steven</creatorcontrib><creatorcontrib>Schueler, Stephan</creatorcontrib><creatorcontrib>Townsend, John</creatorcontrib><creatorcontrib>Venkateswaran, Rajamiyer</creatorcontrib><creatorcontrib>Wilson, Ian</creatorcontrib><creatorcontrib>Winter, Mike</creatorcontrib><creatorcontrib>Steering Group of the UK Cardiothoracic Transplant Audit</creatorcontrib><creatorcontrib>on behalf of the Steering Group of the UK Cardiothoracic Transplant Audit and the UK VAD Forum</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Emin, Akan</au><au>Rogers, Chris A.</au><au>Parameshwar, Jayan</au><au>MacGowan, Guy</au><au>Taylor, Rhiannon</au><au>Yonan, Nizar</au><au>Simon, Andre</au><au>Tsui, Steven</au><au>Schueler, Stephan</au><au>Banner, Nicholas R.</au><au>Banner, Nicholas</au><au>Braidley, Peter</au><au>Burch, Mike</au><au>Clark, Stephen</au><au>Collett, Dave</au><au>Cromwell, David</au><au>Haire, Kate</au><au>Mascaro, Jorge</au><au>Parameshwar, Jayan</au><au>Petrie, Mark</au><au>Simon, Andre</au><au>Tsui, Steven</au><au>Yonan, Nizar</au><au>Collins, Ms Katherine</au><au>Haj-Yahia, Saleem</au><au>MacGowan, Guy</au><au>Shaw, Steven</au><au>Schueler, Stephan</au><au>Townsend, John</au><au>Venkateswaran, Rajamiyer</au><au>Wilson, Ian</au><au>Winter, Mike</au><aucorp>Steering Group of the UK Cardiothoracic Transplant Audit</aucorp><aucorp>on behalf of the Steering Group of the UK Cardiothoracic Transplant Audit and the UK VAD Forum</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Trends in long-term mechanical circulatory support for advanced heart failure in the UK</atitle><jtitle>European journal of heart failure</jtitle><addtitle>European Journal of Heart Failure</addtitle><date>2013-10</date><risdate>2013</risdate><volume>15</volume><issue>10</issue><spage>1185</spage><epage>1193</epage><pages>1185-1193</pages><issn>1388-9842</issn><eissn>1879-0844</eissn><abstract>Aims
Heart transplantation (HTx) is limited by the scarcity of suitable donor hearts. Consequently, more patients with advanced heart failure require a ventricular assist device (VAD). We report UK activity, trends, and outcome for long‐term VAD support as a bridging therapy to HTx.
Methods and results
Patients were grouped into three eras: E1, February 2004–March 2006; E2, April 2006–March 2009; and E3, April 2009–March 2011. Exclusions were patients who received isolated short‐term support or extracorporeal membrane oxygenation without prior or subsequent long‐term VAD support. A total of 247 patients received VAD support; 202 left ventricular (LVAD) support alone and 45 both left and right ventricular support. Activity increased over time, from 36 patients implanted in E1 to 123 in E3. Overall, 46 patients received a first‐generation device, 80 a second‐generation device, and 121 a third‐generation device. Use of third‐generation devices increased from <6% in E1 to 78% in E3. Median duration of LVAD support increased from 141 days in E1 to 578 days in E3 (P < 0.001). Overall survival to 1 year after LVAD implant rose from 58.3% [95% confidence interval (CI) 40.7–72.4%] in E1 to 72.5% (95% CI 63.3–79.8%) in E3 (P = 0.21), and improved significantly with device generation; at 1 year, 50% of patients with first‐generation devices were alive compared with 68.1% and 76.9% of patients with second‐ and third‐generation devices, respectively (P = 0.002). These differences remained after risk adjustment. HTx following LVAD implant reduced over time (P < 0.001).
Conclusion
VAD activity and duration of support have increased. There has been a shift from first‐ and second‐ to third‐generation devices, and an associated improvement in survival.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>23901056</pmid><doi>10.1093/eurjhf/hft127</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1388-9842 |
| ispartof | European journal of heart failure, 2013-10, Vol.15 (10), p.1185-1193 |
| issn | 1388-9842 1879-0844 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1437118518 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Free Content; Alma/SFX Local Collection |
| subjects | Adult Cardiomyopathy, Dilated - complications Cardiomyopathy, Dilated - mortality Cardiomyopathy, Dilated - therapy Cohort Studies ECMO Extracorporeal Membrane Oxygenation - trends Extracorporeal Membrane Oxygenation - utilization Female Heart Failure - etiology Heart Failure - mortality Heart Failure - therapy heart transplantation Heart Transplantation - utilization Heart-Assist Devices - trends Heart-Assist Devices - utilization Humans Intra-Aortic Balloon Pumping - trends Intra-Aortic Balloon Pumping - utilization Male mechanical circulatory support (MCS) Middle Aged Proportional Hazards Models Prospective Studies Severity of Illness Index survival Treatment Outcome United Kingdom ventricular assist device (VAD) |
| title | Trends in long-term mechanical circulatory support for advanced heart failure in the UK |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-19T06%3A08%3A51IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Trends%20in%20long-term%20mechanical%20circulatory%20support%20for%20advanced%20heart%20failure%20in%20the%20UK&rft.jtitle=European%20journal%20of%20heart%20failure&rft.au=Emin,%20Akan&rft.aucorp=Steering%20Group%20of%20the%20UK%20Cardiothoracic%20Transplant%20Audit&rft.date=2013-10&rft.volume=15&rft.issue=10&rft.spage=1185&rft.epage=1193&rft.pages=1185-1193&rft.issn=1388-9842&rft.eissn=1879-0844&rft_id=info:doi/10.1093/eurjhf/hft127&rft_dat=%3Cproquest_cross%3E1437118518%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1437118518&rft_id=info:pmid/23901056&rfr_iscdi=true |